Zurück zur Übersicht
| Journal of hepatology. 2020 Jul 10. pii: S0168-8278(20)30384-6. doi: 10.1016/j.jhep.2020.06.013 |
| The PREDICT study uncovers three clinical courses in acutely decompensated cirrhosis with distinct pathophysiology (120/120). |
| Trebicka J1, Fernandez J2, Papp M3, Caraceni P4, Laleman W5, Gambino C6, Giovo I7, Uschner FE8, Jimenez C9, Mookerjee R10, Gustot T11, Albillos A12, Bañares R13, Janicko M14, Steib C15, Reiberger T16, Acevedo J17, Gatti P18, Bernal W19, Zeuzem S20, Zipprich A21, Piano S22, Berg T23, Bruns T24, Bendtsen F25, Coenraad M26, Merli M27, Stauber R28, Zoller H29, Ramos JP30, Solé C31, Soriano G32, de Gottardi A33, Gronbaek H34, Saliba F35, Trautwein C36, Özdogan OC37, Francque S38, Ryder S39, Nahon P40, Romero-Gomez M41, Van Vlierberghe H42, Francoz C43, Manns M44, Garcia E45, Tufoni M46, Amoros A47, Pavesi M48, Sanchez C49, Curto A50, Pitarch C51, Putignano A52, Moreno E53, Shawcross D54, Aguilar F55, Claria J56, Ponzo P57, Jansen C58, Vitalis Z59, Zaccherini G60, Balogh B61, Vargas V62, Montagnese S63, Alessandria C64, Bernardi M65, Ginès P66, Jalan R67, Moreau R68, Angeli P69, Arroyo V70 |
 Collaborators
|
|
Author information
|
|
Abstract BACKGROUND & AIMS: Acute decompensation (AD) of cirrhosis is defined by the acute development of ascites, gastrointestinal hemorrhage, hepatic encephalopathy, infection or any combination of these, requiring hospitalization. The presence of organ failure(s) in patients with AD defines acute-on-chronic liver failure (ACLF), while their absence defines AD. We designed the PREDICT study, a European, prospective, observational study, to characterize the clinical course of AD and predict ACLF. METHODS: A total of 1071 patients with AD were enrolled to collect detailed pre-specified information on the 3-month period prior to enrollment, and clinical and laboratory data at enrollment. Patients were then closely followed-up for 3 months. The 12-month outcomes (liver transplantation, and death) were also recorded. RESULTS: Three groups of patients were identified: Pre-ACLF patients (n=218), who developed ACLF and had 3-month and 1-year mortality rates of 53.7% and 67.4%, respectively. Unstable decompensated cirrhosis (UDC) patients (n = 233) required ≥1 readmission but not developing ACLF and had 21.0% and 35.6% mortality rates. Stable decompensated cirrhosis (SDC) patients (n = 620) who were neither readmitted, nor developed ACLF and showed a 1-year mortality of only 9.5%. The 3 groups differed significantly in the grade and course of systemic inflammation (high-grade at enrollment with aggravation during follow-up in pre-ACLF; low-grade at enrollment with subsequent steady-course in UDC; and low-grade at enrollment with subsequent improvement in the SDC) and prevalence of surrogates of severe portal hypertension throughout the study (high in UDC versus low in pre-ACLF and SDC). CONCLUSIONS: Acute decompensation without ACLF is a heterogeneous condition with three different clinical courses and two major pathophysiological mechanisms: systemic inflammation and portal hypertension. Prediction of ACLF development remains a major future task. |
|
Copyright © 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved. |
|
KEYWORDS: Chronic liver disease, Non-elective admission, Outcome, Risk factors, acute complications |
|
Publikations ID: 32673741 Quelle: öffnen |
Collaborators
Schnellinfo
-- Cancer Care
-- Kliniken und Partner
-- CCC Cancer School
-- Young CCC
-- CCC Tumorboards
-- CCC Forschungscluster
-- CCC Units
-- CCC Platforms
-- SOPs / Leitlinien
-- Kontakt
Featured
