Acute kidney injury in patients with cirrhosis: Acute Disease Quality Initiative (ADQI) and International Club of Ascites (ICA) joint multidisciplinary consensus meeting

Journal of Hepatology, Journal Year: 2024, Volume and Issue: 81(1), P. 163 - 183

Published: March 26, 2024

Patients with cirrhosis are prone to develop acute kidney injury (AKI), a complication associated markedly increased in-hospital morbidity and mortality, along risk of progression chronic disease. Whereas patients at developing any phenotype AKI, hepatorenal syndrome (HRS), specific form AKI (HRS-AKI) in advanced ascites, carries an especially high mortality risk. Early recognition HRS-AKI is crucial since administration splanchnic vasoconstrictors may reverse the serve as bridge liver transplantation, only curative option. In 2023, joint meeting International Club Ascites (ICA) Acute Disease Quality Initiative (ADQI) was convened new diagnostic criteria for HRS-AKI, provide graded recommendations work-up, management post-discharge follow-up highlight priorities further research.

Language: Английский

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Liver transplantation for acute-on-chronic liver failure

˜The œLancet. Gastroenterology & hepatology, Journal Year: 2024, Volume and Issue: 9(6), P. 564 - 576

Published: Feb. 1, 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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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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Artificial Liver Support Systems in Acute Liver Failure and Acute-on-Chronic Liver Failure: Systematic Review and Meta-Analysis

Critical Care Explorations, Journal Year: 2025, Volume and Issue: 7(1), P. e1199 - e1199

Published: Jan. 1, 2025

OBJECTIVES: To systematically review the safety and efficacy of nonbiological (NBAL) or biological artificial liver support systems (BAL) whole-organ extracorporeal perfusion (W-ECLP) systems, in adults with acute failure (ALF) acute-on-chronic (ACLF). DATA SOURCES: Eligible NBAL/BAL studies from PubMed/Embase searches were randomized controlled trials (RCTs) adult patients ALF/ACLF, greater than equal to ten per group, reporting outcomes related survival, adverse events, transplantation rate, hepatic encephalopathy, published English January 2000 July 2023. Separately, we searched for evaluating W-ECLP ALF ACLF between January1990 STUDY SELECTION AND EXTRACTION: Two researchers independently screened citations eligibility and, eligible studies, retrieved data study characteristics, interventions, definition, intervention effects. The Cochrane Risk Bias 2 tool Joanna Briggs Institute checklists used assess individual risk bias. Meta-analysis mortality at 28–30 days post-support system initiation frequency least one serious event (SAE) generated pooled ratios (RRs), based on random (mortality) fixed effects models. SYNTHESIS: Of 17 11 reported five SAE. Overall, was not statistically associated (RR, 0.85; 95% CI, 0.67–1.07; p = 0.169) SAE 1.15; 0.99–1.33; 0.059), compared standard medical treatment. Subgroup results suggest possible benefit 0.67; 0.44–1.03; 0.069). From six reports (12 patients), more half (58%) severe bridged survived without transmission porcine retroviruses. CONCLUSIONS: Despite no significant devices, available evidence calls further research development larger RCTs optimization patient selection, durability, treatment protocols.

Language: Английский

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Intensive care management of acute-on-chronic liver failure

Intensive Care Medicine, Journal Year: 2023, Volume and Issue: 49(8), P. 903 - 921

Published: Aug. 1, 2023

Language: Английский

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Acute decompensation of cirrhosis versus acute‐on‐chronic liver failure: What are the clinical implications?

United European Gastroenterology Journal, Journal Year: 2024, Volume and Issue: 12(2), P. 194 - 202

Published: Feb. 20, 2024

Abstract It is essential to identify the subgroup of patients who experience poorer outcomes in order adapt clinical management effectively. In context liver disease, earlier identification occurs, greater range therapeutic options that can be offered patients. past, with acute decompensation (AD) chronic disease were treated as a homogeneous group, emphasis on identifying those at highest risk death. last 15 years, differentiation has emerged between acute‐on‐chronic failure syndrome (ACLF) and AD, primarily due indications latter linked less favorable short‐term prognosis. Nevertheless, definition ACLF varies among different knowledge societies, making it challenging assess its true impact compared AD. Therefore, purpose this review provide detailed analysis emphasizing critical importance field advanced disease. We will discuss differences Eastern Western approaches, particularly relation occurrence onset. Common characteristics, such dynamic nature course, highlighted. Finally, we focus two key implications arising from these considerations: prevention before onset strategies once develops, including transplantation withdrawal care.

Language: Английский

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Use of the CytoSorb adsorber in patients with acute-on-chronic liver failure

Scientific Reports, Journal Year: 2024, Volume and Issue: 14(1)

Published: May 17, 2024

Abstract CytoSorb is a hemoadsorptive column used to remove high concentrations of proinflammatory cytokines in septic shock. Data on application acute-on-chronic liver failure (ACLF) lacking. This retrospective observational study analyzed 21 ACLF patients admitted ICUs at the Vienna General Hospital who received adsorber therapy between 2017 and 2023. Median ICU length stay was 8 days (IQR: 3–13), survival rate 23.8% (n = 5). Significant decreases bilirubin (median peak: 20.7 mg/dL median post-treatment: 10.8 mg/dL; − 47.8%; p < 0.001), procalcitonin (1.34 0.74 pg/mL; 44.6%; interleukin-6 (385 131 ng/mL; 66.0%; 0.0182)—but also platelets (72 31 G/L; 56.9%; 0.0014) fibrinogen (230 154 33.0%; 0.0297) were detected. survivors had trend towards stronger relative decrease (− 76.1% vs. 48.2%), 90.6% 23.5%), IL-6 54.6% 17.8%) upon treatment. Moreover, no serious CytoSorb-attributed complications In conclusion, use results significant cytokines, while lowered. Prospective trials are warranted investigate impact clinical outcomes with cytokine levels.

Language: Английский

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Exploring the Relationship between Liver Disease, Bacterial Translocation, and Dysbiosis: Unveiling the Gut-Liver Axis

Visceral Medicine, Journal Year: 2024, Volume and Issue: 40(1), P. 12 - 19

Published: Jan. 1, 2024

<b><i>Background:</i></b> The global burden of liver disease and cirrhosis has been progressively increasing in the last decade. interplay between gut microbiota immune system bidirectional relationship with liver, known as gut-liver axis, arisen a fundamental aspect disease. <b><i>Summary:</i></b> Alterations microbiome have described include both dysbiotic microbial signatures intestinal bacterial overgrowth. integrity epithelial barrier is essential for preventing access harmful substances products into host. Bacterial translocation due to altered host-microbiota interactions triggers local cell activation facilitates chronic inflammatory state that can ultimately lead exhaustion, characteristic cirrhosis. In cirrhosis, breakdown vascular allows portal blood circulation their influx further contributing progression. <b><i>Key Messages:</i></b> A better understanding factors pathological impact dysbiosis will achieve innovative therapeutic strategies

Language: Английский

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Review article: Evaluation and care of the critically ill patient with cirrhosis

Alimentary Pharmacology & Therapeutics, Journal Year: 2024, Volume and Issue: 59(12), P. 1489 - 1509

Published: May 1, 2024

The increase in prevalence of liver disease globally will lead to a substantial incremental burden on intensive care requirements. While transplantation offers potential life-saving intervention, not all patients are eligible due limitations such as organ availability, resource constraints, ongoing sepsis or multiple failures. Consequently, the focus critical with advanced and decompensated cirrhosis turns liver-centric protocols, mitigate high mortality patients.

Language: Английский

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