EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis

Journal of Hepatology, Journal Year: 2018, Volume and Issue: 69(2), P. 406 - 460

Published: April 10, 2018

Language: Английский

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Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update

Hepatology International, Journal Year: 2019, Volume and Issue: 13(4), P. 353 - 390

Published: June 6, 2019

The first consensus report of the working party Asian Pacific Association for Study Liver (APASL) set up in 2004 on acute-on-chronic liver failure (ACLF) was published 2009. With international groups volunteering to join, "APASL ACLF Research Consortium (AARC)" formed 2012, which continued collect prospective patient data. Based data analysis nearly 1400 patients, AARC 2014. In past four-and-a-half years, database has been enriched about 5200 cases by major hepatology centers across Asia. during interim period were carefully analyzed and areas contention new developments field prioritized a systematic manner. also approached answering some issues where limited, such as grading, its impact 'Golden Therapeutic Window', extrahepatic organ dysfunction failure, development sepsis, distinctive features acute decompensation from pediatric analyzed. These initiatives concluded two-day meeting October 2018 at New Delhi with finalization consensus. Only those statements, based evidence using Grade System unanimously recommended, accepted. Finalized statements again circulated all experts subsequently presented investigators AASLD November 2018. suggestions used revise finalize After detailed deliberations analysis, original definition found withstand test time be able identify homogenous group patients presenting failure. management options including algorithms coagulation disorders, renal replacement therapy, variceal bleed, antivirals criteria transplantation proposed. final along relevant background information requiring future studies are here.

Language: Английский

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Acute-on-Chronic Liver Failure Clinical Guidelines

The American Journal of Gastroenterology, Journal Year: 2022, Volume and Issue: unknown

Published: Jan. 10, 2022

In patients with cirrhosis and chronic liver disease, acute-on-chronic failure is emerging as a major cause of mortality. These guidelines indicate the preferred approach to management represent official practice recommendations American College Gastroenterology. The scientific evidence for these was evaluated using Grading Recommendations, Assessment, Development, Evaluation process. instances where not appropriate Evaluation, but there consensus significant clinical merit, key concept statements were developed expert consensus. are meant be broadly applicable should viewed preferred, only, scenarios.

Language: Английский

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Acute-on-chronic liver failure: Terminology, mechanisms and management

Clinical and Molecular Hepatology, Journal Year: 2023, Volume and Issue: 29(3), P. 670 - 689

Published: March 20, 2023

Acute-on-chronic liver failure is an acute deterioration of function manifesting as jaundice and coagulopathy with the development ascites, a high probability extrahepatic organ involvement 28-day mortality. The pathogenesis involves extensive hepatic necrosis, which associated severe systemic inflammation subsequently causes cytokine storm, leading to portal hypertension, dysfunction, failure. These patients have increased gut permeability, releasing lipopolysaccharide (LPS) damage-associated molecular patterns (DAMPS) in blood, hyper-immune activation secretion cytokines, followed by immune paralysis, causing infections proportion patients. Early detection institution treatment, especially "Golden Window" period 7 days, gives opportunity for reversal syndrome. Scores like Asian Pacific Association Study Liver (APASL) ACLF research consortium (AARC) score, model end stage disease (MELD), CLIF Consortium acute-on-chronic (CLIF-C ACLF) score can help prediction Treatment strategy includes treatment insult. Patients should be considered early transplant MELD >28, AARC >10, high-grade encephalopathy, absence >2 or overt sepsis improve survival up 80% at five years. Patients, no option transplant, treated emerging therapies faecal microbial plasma exchange, etc., need further evaluation.

Language: Английский

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Acute-on-chronic liver failure (ACLF): the ‘Kyoto Consensus’—steps from Asia

Hepatology International, Journal Year: 2025, Volume and Issue: 19(1), P. 1 - 69

Published: Feb. 1, 2025

Acute-on-chronic liver failure (ACLF) is a condition associated with high mortality in the absence of transplantation. There have been various definitions proposed worldwide. The first consensus report working party Asian Pacific Association for Study Liver (APASL) set 2004 on ACLF was published 2009, and "APASL Research Consortium (AARC)" formed 2012. AARC database has prospectively collected nearly 10,500 cases from countries Asia-Pacific region. This instrumental developing score grade ACLF, concept 'Golden Therapeutic Window', 'transplant window', plasmapheresis as treatment modality. Also, data key to identifying pediatric ACLF. European Liver-Chronic Failure (EASL CLIF) North American End Stage Disease (NACSELD) West added concepts organ infection precipitants development CLIF-Sequential Organ Assessment (SOFA) NACSELD scores prognostication. Chinese Group Severe Hepatitis B (COSSH) COSSH-ACLF criteria manage hepatitis b virus-ACLF without cirrhosis. literature supports these be equally effective their respective cohorts patients mortality. To overcome differences develop global consensus, APASL took initiative invited stakeholders, including opinion leaders Asia, EASL AASLD, other researchers field identify issues an evidence-based document. document presented hybrid format at annual meeting Kyoto March 2024. 'Kyoto Consensus' below carries final recommendations along relevant background information areas requiring future studies.

Language: Английский

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Acute-on-chronic liver failure in patients with alcohol-related liver disease

Journal of Hepatology, Journal Year: 2019, Volume and Issue: 70(2), P. 319 - 327

Published: Jan. 15, 2019

Language: Английский

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Lactate Improves Prediction of Short‐Term Mortality in Critically Ill Patients With Cirrhosis: A Multinational Study

Hepatology, Journal Year: 2018, Volume and Issue: 69(1), P. 258 - 269

Published: Aug. 6, 2018

Lactate levels and lactate clearance are known predictors of outcome in critically ill patients the intensive care unit (ICU). The prognostic value is not well established liver cirrhosis acute-on-chronic failure (ACLF). aim this study was to assess with cirrhosis. Patients admitted ICU were studied at University Medical Center Hamburg-Eppendorf (n = 566, derivation cohort) Vienna Hospitals Leuven 250, validation cohort). Arterial measured on admission during first 24 hours. followed for 1 year assessed. Admission directly related number organs failing 28-day mortality (area under receiver operating characteristic [AUROC] 0.72; P < 0.001). This also applied follow-up measurements after 6, 12, hours (P 0.001 all, AUROC > 0.70 all). had significant predictive ability elevated serum ≥5 mmol/L. 12-hour (in mmol/L), respectively, identified as 1-year mortality, independent Chronic Liver Failure Consortium score (CLIF-C ACLFs). A lactate-adjusted CLIF-C ACLFs developed ACLFsLact ), which performed significantly better than original prediction cohort. Conclusion: appropriately reflect severity disease organ independently associated short-term a simple but accurate marker, its incorporation improved performance significantly.

Language: Английский

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Acute-on-chronic liver failure: A distinct clinical syndrome

Journal of Hepatology, Journal Year: 2021, Volume and Issue: 75, P. S27 - S35

Published: May 23, 2021

Language: Английский

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Meeting Report: The Dallas Consensus Conference on Liver Transplantation for Alcohol Associated Hepatitis

Liver Transplantation, Journal Year: 2019, Volume and Issue: 26(1), P. 127 - 140

Published: Nov. 19, 2019

Liver transplantation (LT) for alcohol associated hepatitis (AH) remains controversial. We convened a consensus conference to examine various aspects of LT AH. The goal was not unequivocally endorse AH; instead, it propose recommendations programs that perform or plan Criteria were established determine candidacy in the setting AH and included following: (1) patients presenting first time with decompensated liver disease are nonresponders medical therapy without severe psychiatric comorbidities; (2) fixed period abstinence prior is required; (3) assessment multidisciplinary psychosocial team, including social worker an addiction specialist/mental health professional expertise. Supporting factors lack repeated unsuccessful attempts at rehabilitation, other substance use/dependency, acceptance diagnosis/insight commitment patient/family sobriety, formalized agreement adhere total counseling. should be avoided who likely spontaneously recover. Short‐term longterm survival comparable indications must achieved. There further disparity either by indication, geography, sociodemographic factors. Treatment alcohol‐use disorders incorporated into pre‐ post‐LT care. restrictive focused evaluation process described initial experience worldwide may endure as this indication gains wider more programs. Transparency selection crucial requires collection objective data assess outcomes minimize center variation listing. Oversight program adherence important harmonize listing practices outcomes.

Language: Английский

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A multidisciplinary approach to the diagnosis and management of Wilson disease: 2022 Practice Guidance on Wilson disease from the American Association for the Study of Liver Diseases

Hepatology, Journal Year: 2022, Volume and Issue: unknown

Published: Sept. 24, 2022

Schilsky, Michael L.; Roberts, Eve A.; Bronstein, Jeff M.; Dhawan, Anil; Hamilton, James P.; Rivard, Anne Marie; Washington, Mary Kay; Weiss, Karl Heinz; Zimbrean, Paula C. Author Information

Language: Английский

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