Liver diseases and hepatocellular carcinoma in the Asia-Pacific region: burden, trends, challenges and future directions

Nature Reviews Gastroenterology & Hepatology, Год журнала: 2024, Номер 21(12), С. 834 - 851

Опубликована: Авг. 15, 2024

Язык: Английский

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

Hepatology International, Год журнала: 2025, Номер 19(1), С. 1 - 69

Опубликована: Фев. 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.

Язык: Английский

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AKI in ACLF: navigating the complex therapeutic puzzle

Expert Review of Gastroenterology & Hepatology, Год журнала: 2025, Номер unknown

Опубликована: Янв. 18, 2025

Acute kidney injury (AKI) in patients with acute-on-chronic liver failure (ACLF) is driven by the severity of systemic inflammation, acute portal hypertension driving circulatory dysfunction, hyperbilirubinemia, and toxicity bile acids. The spectrum mostly structural, associated reduced response to vasoconstrictors. progression rapid need renal replacement therapy extracorporeal therapies may be required for management. development usually considered when defining syndrome ACLF. In current review we discuss pathophysiological basis, natural course, therapeutic modalities challenges assessing managing AKI We conducted a comprehensive search electronic databases such as PubMed, Web Science, Scopus using keywords like lactate, NGAL, PHTN, well CRRT, PLEX, ACLF, phases our review. Peer-reviewed English papers that addressed issue were considered. difficulties specific management strategies ACLF are discussed emphasizing importance customized protocols, risk assessment guided biomarkers, investigation target

Язык: Английский

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Plasma galectin-3 can be considered as a non-invasive marker to predict the prognosis of ACLF patients with new typing

Scientific Reports, Год журнала: 2025, Номер 15(1)

Опубликована: Янв. 31, 2025

Very recently, we creatively put forward a new classification for ACLF patients, which lays the foundation establishment of prognostic model that can accurately predict prognosis patients. Herein, found: galectin-3 levels were higher in type A patients compared to those B patients; expression was closely correlated with TBil, PTA/INR and MELD; is an independent predictive factor rapid progression ACLF, exhibited superior value than MELD score; survival rate remarkably lower expression. Collectively, be considered as non-invasive biomarker typing. Our findings help advance time window prediction from 4 weeks baseline, thereby identifying who really need liver transplantation earlier improving

Язык: Английский

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The Jieduan-Niwan Formula Reduces Inflammatory Responses in Acute-on-Chronic Liver Failure Rats by Inhibiting HMGB1-Induced Hepatocyte Pyroptosis

Drug Design Development and Therapy, Год журнала: 2025, Номер Volume 19, С. 2503 - 2517

Опубликована: Апрель 1, 2025

Acute-on-chronic liver failure (ACLF) is a global intractable disease. HMGB1-induced hepatocyte pyroptosis expanding inflammatory responses contributes to the pathogenesis of ACLF. The JDNW formula (JDNWF) has significant clinical effect on ACLF, but its hepatoprotective mechanisms remain elusive. To explore potential molecular JDNWF in ACLF by pyroptosis. Rats were divided into normal, Caspase-1 inhibitor, HMGB1 JDNW, JDNW+Caspase-1 inhibitor and JDNW+HMGB1 groups. rat model was established 40% carbon tetrachloride-induced fibrosis, followed intraperitoneal injection D-galactosamine lipopolysaccharide. function, coagulation pathological damage ultrastructural changes hepatocytes evaluated. Triple-immunostaining active Caspase-1, terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) albumin performed evaluate percentage pyroptotic hepatocytes. Western blot, immunofluorescence, enzyme-linked immunosorbent assay (ELISA) quantitative real-time PCR (RT-qPCR) used analyze expressions key genes proteins pathways level factors. improved function damage, reduced responses, down-regulated rats. better than those (glycyrrhizin) (VX-765). Compared with glycyrrhizin or VX-765, there no differences above indicators after combination VX-765. These results indicated that inhibited inflammation rats through pathways. protects livers inhibiting reducing suggesting may be therapeutic target

Язык: Английский

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Integrating prior decompensation into ACLF definition to enhance clinical management

Hepatology International, Год журнала: 2025, Номер unknown

Опубликована: Март 31, 2025

Язык: Английский

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Prognostic factors for mortality in patients with acute-on-chronic liver failure

European Journal of Gastroenterology & Hepatology, Год журнала: 2025, Номер unknown

Опубликована: Фев. 27, 2025

Objective The aim is to explore significant prognostic factors for 90-day mortality in patients with acute-on-chronic liver failure (ACLF) and assist clinicians the early identification of critically ill ACLF patients. Methods A retrospective analysis was conducted on 288 patients, who were classified into survivors ( n = 187) nonsurvivors 101) based outcomes. Multivariate stepwise logistic regression analyses employed identify construct a novel model, AHUCTPI. model’s performance assessed internal validation performed. Additionally, influence dynamic changes laboratory markers examined. Results Independent risk included age ≥45 years, presence hepatic encephalopathy (HE), upper gastrointestinal bleeding (UGB) during hospitalization, imaging-confirmed cirrhosis at admission, elevated baseline total bilirubin (TBIL), reduced platelet-to-neutrophil ratio (PNR), international normalized (INR) P < 0.05 all). AHUCTPI formula as follows: Logit p ) −10.019 + 1.808 × (1 if 0 <45 years) 1.048 HE present, absent) 1.721 UGB 1.362 0.008 TBIL (μmol/L) − 0.039 PNR 1.963 INR. AUHCTPI model demonstrated superior predictive accuracy compared MELD (Model End-Stage Liver Disease) score, area under receiver operating characteristic curve values 0.914 0.739, respectively, calibration curves closely approximating ideal curve. Conclusion complex, syndrome. Age, HE, imaging-diagnosed TBIL, PNR, INR predictors provides excellent discrimination. Dynamic monitoring trends enhances supports timely clinical decision-making.

Язык: Английский

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The prognostic value of sarcopenia in acute-on-chronic liver failure: a systematic review and meta-analysis

BMC Gastroenterology, Год журнала: 2025, Номер 25(1)

Опубликована: Апрель 26, 2025

Sarcopenia is prevalent in patients with chronic liver diseases, especially cirrhosis patients. While sarcopenia identified as a predictor of mortality cirrhosis, its influence on acute-on-chronic failure (ACLF) remains unclear. This systematic review meta-analysis aimed to explore the prognostic value ACLF A comprehensive online literature search was performed Medline (via PubMed), Web Science, Embase, and Cochrane Library, eligible studies were screened according predetermined criteria. The quality included assessed by using revised Collaboration Risk Bias Tool for randomized-control Newcastle-Ottawa Quality Assessment Scale observational studies. Available outcomes measured odds ratio (OR), hazard (HR), risk (RR) 95% confidence interval (CI) extracted further meta-analysis. Stata (version 18.0) used all statistical analyses. Nine analysis. pooled prevalence 53.3% (95% CI: 53.26 - 71.23%). presence positively associated 28-day (HR = 2.11, 1.50-2.95, p < 0.001, I2 0.0%; OR 2.73, 1.37-5.42, 0.004, 0.0%), 90-day 1.66, 1.13-2.46, 0.01, 72.3%), overall 1.81, 1.30-2.51, 0.0%). When continuous variables describe sarcopenia, 1-unit increase these indicators almost significantly related reduced 0.98, 0.95-1.00, 0.052, 0.0%) lower 1-year post-transplantation 0.91, 0.85-0.98, 0.012, 32.7%). Current evidence illustrates that an unfavorable factor both short- long-term prognosis. More are needed validate findings future.

Язык: Английский

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A consensus definition for ACLF- The need of the hour?

Journal of Hepatology, Год журнала: 2024, Номер unknown

Опубликована: Июнь 1, 2024

Язык: Английский

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Liver transplantation for acute liver failure (ALF) and acute-on-chronic liver failure (ACLF)

American Journal of Transplantation, Год журнала: 2024, Номер 24(11), С. 1950 - 1962

Опубликована: Авг. 1, 2024

Язык: Английский

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