Acute-on-chronic liver failure (ACLF) is a clinical entity defined by organ failures and high short-term mortality. However, unlike other diseases that are defined by histology or serologies, ACLF was first defined based on the requirement of a high 28-day mortality rate using a predefined threshold.¹ Despite multiple definitions of ACLF, all require a combination of laboratory and clinical data (e.g., prior decompensations), some of which is only available in the medical record. There have been a series of publications using US transplant registry data from the United Network for Organ Sharing (UNOS) to advocate for changes in transplant policy for patients with ACLF.² In this piece, we discuss the barriers to using transplant registry data to study ACLF.

中文翻译：

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慢加急性肝衰竭和肝移植：在数据分析中本末倒置并提倡 MELD 例外

慢加急性肝衰竭 (ACLF) 是由器官衰竭和高短期死亡率定义的临床实体。然而，与组织学或血清学定义的其他疾病不同，ACLF 最初是根据使用预定义阈值的 28 天高死亡率的要求定义的。¹尽管 ACLF 有多种定义，但所有定义都需要结合实验室和临床数据（例如，既往代偿失调），其中一些仅在医疗记录中可用。已经有一系列出版物使用美国器官共享联合网络 (UNOS) 的移植登记数据来倡导改变 ACLF 患者的移植政策。²在这篇文章中，我们讨论了使用移植登记数据研究 ACLF 的障碍。