2023ACG指南：急性肝衰竭

1128CLINICAL GUIDELINESCMEAcute Liver Failure GuidelinesAlexandra Shingina,MD,MSc',Nizar Mukhtar,MD2,Jamile Wakim-Fleming,MD,FACG2,Saleh Algahtani,MBChB,MS4.5,Robert J.Wong,MD,MS,FACG,Berkeley N.Limketkai,MD,PhD,FACG7,Anne M.Larson,MDe and Lafaine Grant,MD9Acute liver failure (ALF)is a rare,acute,potentially reversible condition resulting in severe liver impairment and rapidclinical deterioration in patients without preexisting liver disease.Due to the rarity of this condition,published studiesare limited by the use of retrospective or prospective cohorts and lack of randomized controlled trials.Current guidelinesrepresent the suggested approach to the identification,treatment,and management of ALF and represent the officialpractice recommendations of the American College of Gastroenterology.The scientific evidence was reviewed using theGrading of Recommendations,Assessment,Development and Evaluation process to develop recommendations.Whenno robust evidence was available,expert opinions were summarized using Key Concepts.Considering the variety ofclinical presentations of ALF,individualization of care should be applied in specific clinical scenarios.KEYWORDS:Acute liver failure;liver transplantation;fulminant liver failure;acute liver injury;jaundice;coagulopathy;hepatotoxicity:multi-organ failure;hepatic encephalopathySUPPLEMENTARY MATERIAL accompanies this paper at http://inks.lww.com/AJG/C963Am J Gastroenterol 2023:118:1128-1153.https://doiorg/10.14309/ajg.0000000000002340:published online March 20,2023INTRODUCTIONbased and population-based factors(3).Furthermore,a narrativeAcuteliver failure(ALF)is a life-threatening condition that occurs inevidence summary for each section provides important definitionspatients with no preexisting liver disease and is characterized by liverand further details for the data supporting the statements.11032023injury (abnormal liver tests),coagulopathy (international normal-Under the auspices of the American College of Gastroen-ized ratio [INR]>1.5),and hepatic encephalopathy (HE).It has aterology (ACG)Practice Parameters Committee,a group ofmultitude ofetiologies and a variety of clinical presentations that canexperts in the area of ALF were identified for the writing group.affect virtually every organ system.It is imperative for dliniciansThe proposed writing group was reviewed by the ACG Practiceto recognize ALF early in patient presentation because initiationParameters Committee and the ACG leadership,and the finalof treatment and transplant considerations could be lifesaving.approved writing group consisted of the current authorshipThe current guideline represents the summary of existing data onteam,which includes hepatologyexperts across a broad range ofdiagnosis and management of patients with ALF.practice settings and different stages of clinical and researchThe guidelineisstructured in the format of statements that werecareer development.Regular meetings were conducted amongconsidered to be dinically imp