Clinical implications of inflammation in patients with cirrhosis DOI Creative Commons
Victoria Kronsten, Debbie L. Shawcross

The American Journal of Gastroenterology, Journal Year: 2024, Volume and Issue: 120(1), P. 65 - 74

Published: Aug. 27, 2024

Cirrhosis-associated immune dysfunction refers to the concurrent systemic inflammation and immunoparesis evident across disease spectrum of chronic liver disease, ranging from low-grade inflammatory plasma milieu that accompanies compensated intense high-grade state with coexistent severe paralysis defines acute decompensation acute-on-chronic failure. Systemic plays a crucial role in course cirrhosis is key driver for progression decompensated cirrhosis. Severe fundamental development organ failure and, its most extreme form, propagates hepatic encephalopathy hepatorenal syndrome-acute kidney injury. It may also be involved pathogenesis further complications such as hepatocellular carcinoma mental illness. Those patients profound have worst prognosis. exerts negative clinical effects through number mechanisms including nitric oxide-mediated increased splanchnic vasodilation, immunopathology, metabolic reallocation.

Language: Английский

EASL Clinical Practice Guidelines on acute-on-chronic liver failure DOI Open Access
Richard Moreau, Marta Tonon, Aleksander Krag

et al.

Journal of Hepatology, Journal Year: 2023, Volume and Issue: 79(2), P. 461 - 491

Published: June 24, 2023

Language: Английский

Citations

126
Liver diseases: epidemiology, causes, trends and predictions DOI Creative Commons

Can Gan,

Yuan Yuan, Haiyuan Shen

et al.

Signal Transduction and Targeted Therapy, Journal Year: 2025, Volume and Issue: 10(1)

Published: Feb. 4, 2025

Abstract As a highly complex organ with digestive, endocrine, and immune-regulatory functions, the liver is pivotal in maintaining physiological homeostasis through its roles metabolism, detoxification, immune response. Various factors including viruses, alcohol, metabolites, toxins, other pathogenic agents can compromise function, leading to acute or chronic injury that may progress end-stage diseases. While sharing common features, diseases exhibit distinct pathophysiological, clinical, therapeutic profiles. Currently, contribute approximately 2 million deaths globally each year, imposing significant economic social burdens worldwide. However, there no cure for many kinds of diseases, partly due lack thorough understanding development these Therefore, this review provides comprehensive examination epidemiology characteristics covering spectrum from conditions manifestations. We also highlight multifaceted mechanisms underlying initiation progression spanning molecular cellular levels networks. Additionally, offers updates on innovative diagnostic techniques, current treatments, potential targets presently under clinical evaluation. Recent advances pathogenesis hold critical implications translational value novel strategies.

Language: Английский

Citations

3
Acute-on-chronic liver failure (ACLF): the ‘Kyoto Consensus’—steps from Asia DOI Creative Commons
Ashok Choudhury, Anand V. Kulkarni, Vinod Arora

et al.

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

Citations

2
Association of Direct-Acting Antiviral Therapy With Liver and Nonliver Complications and Long-term Mortality in Patients With Chronic Hepatitis C DOI
Eiichi Ogawa,

Nicholas Chien,

Leslie Y. Kam

et al.

JAMA Internal Medicine, Journal Year: 2022, Volume and Issue: 183(2), P. 97 - 97

Published: Dec. 12, 2022

Chronic hepatitis C (CHC) and its complications are associated with high rates of morbidity mortality. However, large-scale data analysis the long-term liver nonliver effects direct-acting antiviral (DAA) treatment has been limited.To assess association virus elimination through DAA risk mortality during follow-up among a large nationwide cohort insured patients CHC in US.This was retrospective study 245 596 adult using from Optum Clinformatics Data Mart database, 2010 to 2021. Of total cohort, 40 654 had received 1 or more prescriptions for medication (without interferon), 204 942 were untreated.Treatment DAA.Incidence hepatocellular carcinoma (HCC), decompensation, relevant events (nonliver cancer, diabetes, chronic kidney disease, cardiovascular disease), overall mortality.The DAA-treated (vs untreated) older (mean [SD] age, 59.9 [10.8] vs 58.5 [13.0] years; P < .001); likely be male (25 060 [62%] 119 727 [58%] men; .001) White (23 937 [59%] 115 973 [57%]; individuals; have diabetes (10 680 [26%] 52 091 [25%]; cirrhosis (17 971 [44%] 60 094 [29%]; .001). Comparing untreated patients, incidence (per 1000 person-years) outcomes (eg, 28.2 [95% CI, 27.0-29.4] 40.8 40.1-41.5]; .001, HCC compensated cirrhosis, 20.1 18.4-21.9] 41.8 40.3-43.3]; 30.2 35.4-37.7] 37.2 36.6-37.9]; .001; 31.1 29.9-32.2] 34.1 33.5-34.7]; significantly lower treated patients. The all-cause per person-years also compared (mortality, 36.5 64.7 63.9-65.4]; In multivariable regression analysis, independently significant decrease (adjusted hazard ratio [aHR] HCC, 0.73; 0.36), (aHR 0.74; 0.81; 0.90; 0.89), (aHR, 0.43).The findings this indicate that improved liver- outcomes, ultimately, survival.

Language: Английский

Citations

51
Risk of further decompensation/mortality in patients with cirrhosis and ascites as the first single decompensation event DOI Creative Commons
Lorenz Balcar, Marta Tonon, Georg Semmler

et al.

JHEP Reports, Journal Year: 2022, Volume and Issue: 4(8), P. 100513 - 100513

Published: June 3, 2022

Although ascites is the most frequent first decompensating event in cirrhosis, clinical course after as

Language: Английский

Citations

49
Diabetes and cirrhosis: Current concepts on diagnosis and management DOI
Laurent Castéra, Kenneth Cusi

Hepatology, Journal Year: 2023, Volume and Issue: 77(6), P. 2128 - 2146

Published: Jan. 12, 2023

Type 2 diabetes mellitus is often associated with cirrhosis as comorbidities, acute illness, medications, and other conditions profoundly alter glucose metabolism. Both are closely related in NAFLD, the leading cause of chronic liver disease, given its rising burden worldwide, management type will be an increasingly common dilemma. Having increases cirrhosis-related complications, including HCC well overall mortality. In absence effective treatments for cirrhosis, patients should systematically screened early possible NAFLD-related fibrosis/cirrhosis using noninvasive tools, starting a FIB-4 index followed by transient elastography, if available. people diagnosis critical optimal strategy (ie, nutritional goals, glycemic targets). Diagnosis may missed based on A1C impaired function (Child-Pugh B–C) anemia turn test unreliable. Clinicians must also become aware their high risk hypoglycemia, especially decompensated where insulin only therapy. Care within multidisciplinary teams (nutritionists, obesity teams, endocrinologists, hepatologists, others) take advantage novel glucose-monitoring devices. familiar safety efficacy medications advanced fibrosis compensated cirrhosis. Management conditioned whether patient has either or This review gives update complex relationship between mellitus, focus treatment, highlights knowledge gaps future directions.

Language: Английский

Citations

38
A new clinical and prognostic characterization of the patterns of decompensation of cirrhosis DOI Creative Commons
Marta Tonon, Roberta D’Ambrosio, Valeria Calvino

et al.

Journal of Hepatology, Journal Year: 2023, Volume and Issue: 80(4), P. 603 - 609

Published: Dec. 17, 2023

The prognostic impact of acute decompensation (AD), i.e. the development complications that require hospitalization, has recently been assessed. However, cirrhosis do not necessarily hospitalization and can develop progressively, as in defined non-acute (NAD). Nevertheless, there is no data regarding incidence NAD. aim study was to evaluate NAD AD outpatients with cirrhosis.

Language: Английский

Citations

27
Emerging role of statin therapy in the prevention and management of cirrhosis, portal hypertension, and HCC DOI Open Access
Suzanne R. Sharpton, Rohit Loomba

Hepatology, Journal Year: 2023, Volume and Issue: 78(6), P. 1896 - 1906

Published: Jan. 3, 2023

Statins, the most widely used lipid-lowering drugs, are increasingly recognized to have pleiotropic effects including anti-inflammatory and antiangiogenic properties as well on fibrogenesis liver endothelial function. Given these pathophysiological effects, there is a growing interest in clinical use of statins persons with cirrhosis. In this review, we summarize available data regarding safety, adverse pharmacokinetics We review evidence, derived primarily from retrospective cohort population-based studies, association between statin reduction risk for hepatic decompensation mortality established also evidence date portal hypertension chemoprevention HCC. Finally, highlight ongoing prospective randomized controlled trials that expect will expand our understanding pharmacokinetics, efficacy cirrhosis guide practice.

Language: Английский

Citations

26
Recent advances in the prevention and treatment of decompensated cirrhosis and acute-on-chronic liver failure (ACLF) and the role of biomarkers DOI Creative Commons
Jonel Trebicka, Rubén Hernáez, Debbie L. Shawcross

et al.

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

Citations

11
Acute and non‐acute decompensation of liver cirrhosis (47/130) DOI Creative Commons
Martin S. Schulz, Paolo Angeli, Jonel Trebicka

et al.

Liver International, Journal Year: 2024, Volume and Issue: unknown

Published: March 1, 2024

Abstract In the traditional view, occurrence of cirrhosis‐related complications, such as hepatic encephalopathy, formation ascites or variceal haemorrhage, marks transition to decompensated stage cirrhosis. Although dichotomous stratification into a compensated and state reflects prognostic water‐shed moment remains hold its validity, it represents an oversimplification clinical realities. A broadening understanding pathophysiological mechanisms underpinning decompensation have led identification distinct subgroups, associated with different courses following decompensation. Data provided by PREDICT study uncovered three sub‐phenotypes acute (AD). Moreover, acute‐on‐chronic liver failure (ACLF) has been established entity for many years, which is high short‐term mortality. Recently, non‐acute (NAD) proposed pathway decompensation, complementing current concepts spectrum contrast AD, NAD characterized slow progressive development are often presented at first and/or in patients earlier chronic disease. Successful treatment AD may lead stabilization even concept recompensation. This review aims provide overview on delineate recent advances our understanding.

Language: Английский

Citations

9