Trends and the course of liver cirrhosis and its complications in Germany: Nationwide population-based study (2005 to 2018)

The Lancet Regional Health - Europe, Journal Year: 2021, Volume and Issue: 12, P. 100240 - 100240

Published: Nov. 4, 2021

Cirrhosis is known to have a high prevalence and mortality worldwide. However, in Europe, the epidemiology of cirrhosis possibly undergoing demographic changes, etiologies may changed due improvements standard care. The aim this population-based study was analyze trends course liver its complications recent years Germany.

Language: Английский

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Infections in cirrhosis

˜The œLancet. Gastroenterology & hepatology, Journal Year: 2024, Volume and Issue: 9(8), P. 745 - 757

Published: May 13, 2024

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: 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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Critical care hepatology: definitions, incidence, prognosis and role of liver failure in critically ill patients

Critical Care, Journal Year: 2022, Volume and Issue: 26(1)

Published: Sept. 26, 2022

Abstract Organ dysfunction or overt failure is a commonplace event in the critically ill affecting up to 70% of patients during their stay ICU. The outcome depends on resolution impaired organ function, while domino-like deterioration organs other than primarily affected ones paves way for increased mortality. “Acute Liver Failure” was defined 1970s as rare and potentially reversible severe liver injury absence prior disease with hepatic encephalopathy occurring within 8 weeks. Dysfunction general reflects critical “Multiple Syndrome” due immunologic, regulatory metabolic functions parenchymal non-parenchymal cells. Dysregulation inflammatory response, persistent microcirculatory (hypoxic) impairment drug-induced are leading problems that result “secondary failure,” i.e., acquired without underlying preexisting (chronic) (“Acute-on-Chronic Failure”). Conventional laboratory markers, such transaminases bilirubin, limited provide insight into complex facets immunologic dysfunction. Furthermore, inhomogeneous definitions these entities lead widely ranging estimates incidence. In present work, we review different improve understanding perpetrator (and therapeutic target) multiple syndrome care. Graphic

Language: Английский

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Global hemostatic profiling in patients with decompensated cirrhosis and bacterial infections

JHEP Reports, Journal Year: 2022, Volume and Issue: 4(7), P. 100493 - 100493

Published: April 20, 2022

Bacterial infections in cirrhosis are associated with increased bleeding risk. To assess the factors responsible for tendency patients bacterial infections, we conducted a prospective study comparing all 3 aspects of hemostasis (platelets, coagulation, and fibrinolysis) hospitalized decompensated vs. without infections.Primary assessment included whole blood platelet aggregation von Willebrand factor (VWF). Coagulation procoagulant (fibrinogen, II, V, VII, VIII, IX, X, XI, XII, XIII), natural anticoagulants (protein C, protein S, antithrombin) thrombomodulin-modified thrombin generation test. Fibrinolysis fibrinolytic (plasminogen, t-PA, PAI-1, α2-AP, TAFIa/ai) plasmin-antiplasmin complex (PAP).Eighty were (40 40 infections). Severity count comparable between groups. At baseline, had significantly lower aggregation, significant differences VWF. Regarding reduced VII reduction anticoagulants. However, was Finally, although mixed potentially hypo-fibrinolytic (lower plasminogen) hyper-fibrinolytic (higher t-PA) changes present level PAP detected both Upon resolution infection (n = 29/40), further deteriorated whereas coagulation fibrinolysis returned to levels observed infections.In cirrhosis, decrease anticoagulants, which may unbalance increase risk thrombosis.Bacterial common issue (i.e. due severe complications advanced chronic liver disease). Patients who acquire be at following invasive procedures (that is procedure body penetrated or entered, instance by needle tube). As high decompensation death, there an urgent need understand such tendency. Herein, investigated alterations physiological process clot formation stability) infections. We found that development these (particularly platelets clotting cascade) thrombotic complications.

Language: Английский

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Sympathetic nervous activation, mitochondrial dysfunction and outcome in acutely decompensated cirrhosis: the metabolomic prognostic models (CLIF-C MET)

Gut, Journal Year: 2023, Volume and Issue: 72(8), P. 1581 - 1591

Published: Feb. 14, 2023

Background and aims Current prognostic scores of patients with acutely decompensated cirrhosis (AD), particularly those acute-on-chronic liver failure (ACLF), underestimate the risk mortality. This is probably because systemic inflammation (SI), major driver AD/ACLF, not reflected in scores. SI induces metabolic changes, which impair delivery necessary energy for immune reaction. investigation aimed to identify metabolites associated short-term (28-day) death design metabolomic models. Methods Two prospective multicentre large cohorts from Europe investigating ACLF development ACLF, CANONIC (discovery, n=831) PREDICT (validation, n=851), were explored by untargeted serum metabolomics validate could allow improved modelling. Results Three strongly selected build 4-Hydroxy-3-methoxyphenylglycol sulfate a norepinephrine derivative, may be derived brainstem response SI. Additionally, galacturonic acid hexanoylcarnitine are mitochondrial dysfunction. Model 1 included only these three age. 2 was built around 4-hydroxy-3-methoxyphenylglycol sulfate, hexanoylcarnitine, bilirubin, international normalised ratio (INR) In discovery cohort, both models more accurate predicting within 7, 14 28 days after admission compared MELDNa score (C-index: 0.9267, 0.9002 0.8424, 0.9369, 0.9206 0.8529, model 2, respectively). Similar results found validation cohort 0.940, 0.834 0.791, 0.947, 0.857 0.810, Also, outperformed prediction Conclusions Models including (CLIF-C MET) reflecting SI, dysfunction sympathetic system activation better predictors mortality than based on organ (eg, MELDNa), especially ACLF.

Language: Английский

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Roles of systemic inflammatory and metabolic responses in the pathophysiology of acute-on-chronic liver failure

JHEP Reports, Journal Year: 2023, Volume and Issue: 5(9), P. 100807 - 100807

Published: June 8, 2023

Acute-on-chronic liver failure (ACLF) is the most severe form of acutely decompensated cirrhosis and characterised by presence one or more organ failures, intense systemic inflammation, peripheral blood lymphopenia, a high risk death without transplantation within 28 days. Herein, we propose hypothesis that inflammation may lead to failures through five different non-mutually exclusive mechanisms. First, pathogen-associated molecular patterns inflammatory mediators (i.e. cytokines lipid mediators) stimulate production vasorelaxant nitric oxide in walls splanchnic arterioles, leading enhanced vasodilation which, turn, induces activity endogenous vasoconstrictor systems causing renal vasoconstriction acute kidney injury. Second, neutrophils reach circulation are prone adhere vascular endothelium. Cytokines act on endothelium microvessels vital organs, an effect favours migration (and probably other leukocytes) surrounding tissues where can cause tissue damage thereby contribute failure. Third, promote formation microthrombi impair microcirculation oxygenation. Fourth, stimulates catabolism amino acids whose products be metabotoxins hepatic encephalopathy. Fifth, responses, which include broad variety biomolecules (proteins lipids), increase biomass (i.e., granulopoiesis requiring de novo nucleotide synthesis), among others, energetically expensive processes require large amounts nutrients. Therefore, immunity competes with maintenance programmes for energy. The brain stem integrates energy demand each system, considered top priority. "decide" make trade-off involves induction dormancy programme permits shutdown mitochondrial respiration oxidative phosphorylation organs. In context cirrhosis, consequence ATP would dramatic decrease function.

Language: Английский

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Acute-on-chronic liver failure – steps towards harmonization of the definition!

Journal of Hepatology, Journal Year: 2024, Volume and Issue: 81(2), P. 360 - 366

Published: March 28, 2024

Language: Английский

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Recent advances in the prevention and treatment of decompensated cirrhosis and acute-on-chronic liver failure (ACLF) and the role of biomarkers

Gut, Journal Year: 2024, Volume and Issue: 73(6), P. 1015 - 1024

Published: March 25, 2024

The progression of cirrhosis with clinically significant portal hypertension towards decompensated remains challenging and the evolution acute-on-chronic liver failure (ACLF), one or more extrahepatic organ failures, is associated very high mortality. In last decade, progress has been made in understanding mechanisms leading to decompensation ACLF. As advances, bacterial translocation across an impaired gut barrier culminates endotoxaemia, systemic inflammation cirrhosis-associated immune dysfunction (CAID). Gut-derived CAID have become logical targets for innovative therapies that prevent hepatic episodes Furthermore, classification disease biomarker discovery personalise care advanced field. This review discusses personalisation treatment

Language: Английский

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