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

United European Gastroenterology Journal, Год журнала: 2024, Номер 12(2), С. 194 - 202

Опубликована: Фев. 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.

Язык: Английский

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A nomogram model based on albumin-bilirubin score for predicting 90-day prognosis in patients with acute-on-chronic liver failure

Frontiers in Medicine, Год журнала: 2025, Номер 11

Опубликована: Янв. 6, 2025

To develop a nomogram model based on the albumin-bilirubin (ALBI) score for predicting 90-day prognosis of patients with acute-on-chronic liver failure (ACLF) and to evaluate its predictive efficacy. Clinical data 290 ACLF at Third People's Hospital Nantong City, collected from December 2020 2023, were analyzed. The divided into training set (n = 200) validation 90), August 2022 as cut-off date. Patients in categorized an improvement group 133) mortality 67) their outcomes. power baseline parameters was assessed using univariate multivariate logistic regression construct model. Model performance receiver operating characteristic (ROC) curves, calibration decision curve analysis (DCA) Hosmer-Lemeshow test. Creatinine (CR) [odds ratio (OR) 1.013, 95% confidence interval (CI): 1.004-1.022], ALBI (OR 10.831, CI: 4.009-33.247), Gender 1.931, 0.973-3.870) ascites 3.032, 1.249-8.178) identified independent prognostic factors. formula derived index (PI) -0.591 + 0.658 × 1.109 0.012 CR 2.382 ALBI. area under (AUC) 0.804 (95% 0.741-0.866), specificity 85.0% sensitivity 65.7% 0.425. AUC 0.811 0.697-0.926). test indicated good fit p-value 0.287 0.423 set. Calibration curves demonstrated accuracy model, DCA results suggested that clinically useful when threshold below 0.6. incorporating CR, can predict patients, potentially helping optimize treatment strategies improve patient

Язык: Английский

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Acute and acute‐on‐chronic liver failure: Pathogenesis, management and perspectives

Liver International, Год журнала: 2025, Номер 45(2)

Опубликована: Янв. 28, 2025

Acute liver failure (ALF) and acute-on-chronic (ACLF) represent critical junctures in the spectrum of diseases, characterized by rapid deterioration function often multi-organ dysfunction. Despite advances medical care, they remain significant challenges clinical practice, necessitating a deeper understanding their pathophysiology development effective therapeutic strategies. This special issue intents to address these topics 15 selected reviews. The first two reviews are ALF pathogenesis therapy focus.1, 2 is rare but life-threatening condition sudden loss individuals with no pre-existing disease. It associated high mortality rate, typically ranging from 50% 80%. aetiology can be diverse, including viral hepatitis, drug-induced injury, autoimmune hepatitis acute ischaemic injury among others (Figure 1). Regardless underlying cause, hallmark massive hepatocyte death, leading impaired synthetic metabolic functions liver. presentation vary widely, common features include jaundice, coagulopathy, hepatic encephalopathy, often, deterioration. management involves intensive supportive measures maintain hemodynamic stability, correct coagulopathy manage complications such as cerebral oedema encephalopathy.1 Liver transplantation remains only definitive treatment option for many patients ALF, offering possibility long-term survival. However, availability donor organs timing crucial factors that significantly impact outcomes. In recent years, there has been growing interest artificial support systems bridge or promote regeneration ALF. These aim remove toxins, imbalances provide temporary while awaiting recovery transplantation. Various modalities, extracorporeal devices bioartificial systems, have investigated, efficacy subject debate.2 ACLF, on other hand, represents distinct syndrome chronic disease, most commonly cirrhosis. Hernaez colleagues summarized comprehensive review definition, diagnosis epidemiology ACLF.3 ACLF develops setting decompensation may also develop stage decompensation, so-called non-acute decompensation.4 For precipitating event, bacterial infection, alcoholic gastrointestinal bleeding, triggers systemic inflammatory response exacerbates injury. But necessary interventions 2) induce precipitate Praktiknjo et al.5 dysregulated immune leads widespread tissue damage organ dysfunction, extra-hepatic failures, driving extreme short-term 30% 50%.6 Alcoholic specific trigger still unaddressed condition.7 Similarly hepatitis,7 complex multifactorial, involving interactions between system, gut microbiota inflammation. progress made, we expect technological (omics) digital (artificial intelligence) improve understanding, potentially design approaches.8 Especially using large cohorts omics data sets will facilitate construction algorithms predict prognosis ACLF. Existing future reviewed Valainathan al.9 Current focuses treating factors, providing care and, some cases, considering life-saving intervention.10 role inflammation dysregulation demonstrated over last this exploration novel targets, interleukin-22 Hwang al.11 Strategies aimed at modulating response, corticosteroids, immunomodulatory agents anti-inflammatory cytokines, shown promise preclinical studies early-phase trials.12 approaches multimodal, indeed, one shape strategy based molecular mechanism supporting clear rationale 3), nicely Morrison al.13 addition pharmacological interventions, increasing use potential support, toxins mediators, regeneration. While early promising results, larger randomized controlled trials needed establish ACLF.14, conclusion, morbidity mortality. need further research better understand conditions more targeted therapies holds improving outcomes validate safety practice. Jonel Trebicka was supported German Research Foundation (DFG) project ID 403224013—SFB 1382 (A09), Federal Ministry Education (BMBF) DEEP-HCC Hessian Higher Education, Arts (HMWK) ENABLE ACLF-I cluster projects. MICROB-PREDICT (project 825694), DECISION 847949), GALAXY 668031), LIVERHOPE 731875) IHMCSA 964590) projects received funding European Union's Horizon 2020 innovation program. manuscript reflects authors' views, Commission not responsible any made information it contains. funders had influence study design, collection analysis, decision publish preparation manuscript. speaking and/or consulting fees Versantis, Gore, Boehringer-Ingelheim, Falk, Grifols, Genfit CSL Behring. article does contain primary patient nor did involve human animal subjects. As such, ethical approval required production article. data, materials sources. authors writing assistance disclose. editorial present new synthesis existing findings. Therefore, sets, code submission. All included publicly available literature references cited within text.

Язык: Английский

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Single‐Cell Transcriptome Identifies a Proinflammatory B‐Cell Subset in Hepatitis B Virus Associated Acute‐on‐Chronic Liver Failure

Journal of Viral Hepatitis, Год журнала: 2025, Номер 32(3)

Опубликована: Фев. 20, 2025

Acute-on-chronic liver failure (ACLF) is a severe clinical condition with high short-term mortality, in part due to the dysfunctional immune response. Identifying mechanism under ACLF critical understand its pathogenesis and develop novel targeted therapeutics. Among cells, how are B cells involved remains largely unknown. We performed scRNA-seq on peripheral blood mononuclear from patients healthy controls. Integrated analysis was identify role of ACLF. Subsequently, different subsets were validated through flow cytometry based their highlighted markers. Six B-cell subgroups, including naive B2 nonclass-switched memory class-switched autoimmune-related plasma identified. The proportions significantly expand ACLF, compared control. Function enrichment revealed activation inflammatory response cells. Further confirmed elevated circulating Our study uncovered altered landscape after proportion dynamics functional perturbation indicate potential as intervention targets future therapy.

Язык: Английский

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Comparison of Open Albumin Dialysis (OPAL) With Prometheus Fractionated Plasma Separation and Adsorption (FPSA) and Standard Medical Treatment for Acute‐On‐Chronic Liver Failure

Artificial Organs, Год журнала: 2025, Номер unknown

Опубликована: Фев. 25, 2025

ABSTRACT Background Acute‐on‐chronic liver failure (ACLF) is associated with high short‐term mortality of up to 40%. Albumin dialysis a therapeutic option that can be used bridge patients ACLF transplantation or recovery. Methods This retrospective cohort study was conducted determine the effectiveness and adverse effects open albumin (OPAL) by comparing biochemical clinical variables model for end‐stage disease (MELD)‐matched who received one three treatments: OPAL plus standard medical treatment (SMT; 22 patients), Prometheus fractionated plasma separation adsorption (FPSA) SMT (41 hemodialysis (24 patients) at University Hospital Essen. Results significantly reduced function tests such as bilirubin ( p = 0.0001) creatinine levels 0.049). Therefore, therapy MELD score 0.001) Chronic Liver Failure Consortium (CLIF‐C) 0.0005) score. In both extracorporeal support groups, decrease in stronger than achieved (OPAL vs. SMT, 0.002; 0.0001; 0.90). comparison group, survival rates after 14 30 days were higher group 0.0008 0.03) tended better although statistical significance not reached 0.06 0.11). Conclusions Our analysis revealed an efficient method yielding reduction improving scoring patients. well relevant amelioration SMT. However, it should considered from older experienced progressive risks compared groups. Thus, when interpreting results, several limitations including small sample size heterogeneity groups due lack randomization taken into account.

Язык: Английский

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Acute-on-Chronic Liver Failure: Steps Towards Consensus

Diagnostics, Год журнала: 2025, Номер 15(6), С. 751 - 751

Опубликована: Март 17, 2025

Acute-on-chronic liver failure (ACLF) is a clinical syndrome characterized by organ and high short-term mortality. Since its first definition in 2013, many international organizations have defined this and, till now, there has been no agreement regarding definitions diagnostic criteria. Although the precise mechanism of ACLF unknown, precipitant factors systemic inflammation response play major role. Specific management high-mortality still under development, but general consensus diagnosis needed.

Язык: Английский

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Value of FIB-4 Index and APRI Score in Predicting Prognosis of Patients with Acute-on-Chronic Hepatitis B Liver Failure

Advances in Clinical Medicine, Год журнала: 2025, Номер 15(04), С. 1453 - 1465

Опубликована: Янв. 1, 2025

Язык: Английский

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The Kidney and Extracorporeal Therapies in Acute‐on‐Chronic Liver Failure: What the Nephrologist Needs to Know

Nephrology, Год журнала: 2025, Номер 30(4)

Опубликована: Апрель 1, 2025

ABSTRACT In this review, we discuss the pathophysiology and management of acute kidney injury (AKI) in setting acute‐on‐chronic liver failure (ACLF). ACLF is characterised by occurrence hepatic and/or extrahepatic organ failure, induced immune dysregulation systemic inflammation patients with chronic disease. Kidney involvement common, AKI occurring 30% to > 95% patients, depending on definition used. Since there a lack biopsy data these underlying pathophysiological basis remains incompletely understood, believed be primary driver injury. The has been largely extrapolated from studies decompensated cirrhosis, little specifically setting. However, available evidence suggests that structural more common than CLD, therefore, less likely respond volume repletion vasopressors. Treatment options remain limited for those who are non‐responsive intravenous fluids Liver transplantation (LT), or without transplantation, definitive treatment patients. At present, extracorporeal therapies such as therapeutic plasma exchange replacement play supportive role bridge LT; however, optimal timing dosing unclear. While theoretically, have potential reverse halt progression damage ACLF, currently.

Язык: Английский

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Baicalein upregulates macrophage TREM2 expression via TrKB-CREB1 pathway to attenuate acute inflammatory injury in acute-on-chronic liver failure

International Immunopharmacology, Год журнала: 2024, Номер 139, С. 112685 - 112685

Опубликована: Июль 23, 2024

Язык: Английский

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Mechanisms and implications of recompensation in cirrhosis

JHEP Reports, Год журнала: 2024, Номер 6(12), С. 101233 - 101233

Опубликована: Окт. 10, 2024

Decompensated cirrhosis has long been considered an irreversible end stage of liver disease, characterized by further decompensating events until death or transplantation. However, the observed clinical improvements after effective antiviral treatments for HBV and HCV sustained alcohol abstinence have changed this paradigm, leading to concept "cirrhosis recompensation". Recompensation recently defined BAVENO VII patients with (i) cure primary disease etiology; (ii) disappearance signs decompensation (ascites, encephalopathy portal hypertensive bleeding) off therapy; (iii) stable improvement function tests (bilirubin, INR albumin). Achieving these recompensation criteria is linked a significant survival benefit. next etiological therapies, no interventions/treatments that facilitate are available, molecular mechanisms underlying remain incompletely understood, early predictors lacking. Moreover, current based on expert opinion may be refined in future.Herein we review available evidence recompensation, provide guidance management recompensated discuss future challenges related recompensation.

Язык: Английский

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