4.7 Review

Organ dysfunction and failure in liver disease

Related references

Note: Only part of the references are listed.
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Pulmonary impairment independently determines mortality in critically ill patients with acute-on-chronic liver failure

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Summary: In ACLF patients, both pulmonary failure and mechanical ventilation are associated with worse prognosis. The grade of pulmonary impairment should be considered in the risk assessment for ACLF patients.

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Summary: The study revealed high global prevalence and mortality rates of ACLF, with regional variations possibly explained by triggers/aetiology of CLD or grade.
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Summary: In this study, we found that the categorization of ACLF by UNOS showed weak agreement with manual chart review. These findings are informative for ongoing allocation policy discussions, highlight the importance of prospective studies regarding ACLF in liver transplantation, and should encourage UNOS reform.

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Summary: Acute-on-chronic liver failure (ACLF) is a condition in cirrhosis associated with organ failure (OF) and high short-term mortality. The EASL-CLIF and NACSELD ACLF definitions have been shown to predict ACLF prognosis effectively. Both systems provide valuable information for predicting in-hospital mortality in patients with decompensated cirrhosis.

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Urinary L-FABP is a promising prognostic biomarker of ACLF and mortality in patients with decompensated cirrhosis

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Summary: This study found that in patients with decompensated cirrhosis, urinary L-FABP levels are independently associated with the 3-month clinical course and can predict mortality and ACLF development.

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Summary: Patients with cirrhosis experience complex changes in their haemostatic system, but it remains balanced overall. New understanding of clinical management for patients with cirrhosis has emerged, although there is a lack of solid evidence from well-designed clinical studies. The paper outlines recent advances in bleeding and thrombotic complications in patients with cirrhosis.

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Summary: The use of terlipressin in patients with HRS1 and ACLF may increase the incidence of RF, especially in patients with grade 3 ACLF. Patients with hypoxemia are at an increased risk of RF and mortality.

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Alterations in Gut Microbiome in Cirrhosis as Assessed by Quantitative Metagenomics: Relationship With Acute-on-Chronic Liver Failure and Prognosis

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Response to Terlipressin and Albumin Is Associated With Improved Liver Transplant Outcomes in Patients With Hepatorenal Syndrome

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Summary: The response to treatment with terlipressin and albumin in patients with AKI-HRS can reduce the need for renal replacement therapy after liver transplantation (LT) and decrease the risk of chronic kidney disease (CKD) at 1 year post-LT.

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Systemic inflammation increases across distinct stages of advanced chronic liver disease and correlates with decompensation and mortality

Dalila Costa et al.

Summary: This study revealed significant differences in liver function, portal hypertension, and systemic inflammation among patients with advanced chronic liver disease at different prognostic stages, with IL-6 levels proving to be predictive of decompensation and mortality risk in decompensated patients.

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The systemic inflammation hypothesis: Towards a new paradigm of acute decompensation and multiorgan failure in cirrhosis

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Summary: Systemic inflammation may be a key feature of acute decompensation of cirrhosis, affecting organ system function through various mechanisms and working synergistically with traditional pathways to contribute to the development of AD. It can exacerbate splanchnic vasodilation by overactivating the endogenous vasoconstrictor systems, leading to hypoperfusion in certain vascular beds such as the renal circulation. Additionally, systemic inflammation may cause immune-mediated tissue damage and induce significant metabolic changes.

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Summary: The study confirmed the efficacy of terlipressin plus albumin in treating type 1 hepatorenal syndrome, but also identified serious adverse events such as respiratory failure.

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Acute-on-Chronic Liver Failure in Cirrhosis

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Summary: ACLF is a syndrome that develops in patients with acutely decompensated chronic liver disease, characterized by high mortality, organ failures, and systemic inflammation. Different scientific societies have proposed diagnostic criteria and clinical characteristics for ACLF, along with established and experimental treatments. Further research is needed to better understand the pathophysiology of the syndrome and explore new therapies.

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Liver transplantation for patients with acute-on-chronic liver failure (ACLF) in Europe: Results of the ELITA/EF-CLIF collaborative study (ECLIS)

Luca S. Belli et al.

Summary: This study reveals significant variations in the listing of patients with ACLF in Europe despite favorable post-LT survival. Risk factors for post-LT mortality were identified, enabling a more precise prognostic assessment of patients with ACLF.

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PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis

Jonel Trebicka et al.

Summary: This study analyzed the precipitants leading to acute decompensation in cirrhosis patients, identifying proven bacterial infections and severe alcoholic hepatitis as the main causes. The number of precipitants was significantly associated with 90-day mortality, emphasizing the need for specific preventive and therapeutic strategies targeting these events.

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Summary: Bacterial infections are common in cirrhotic patients with acute decompensation or acute-on-chronic liver failure, while fungal infections are less common but associated with high short-term mortality. Early diagnosis and appropriate empirical treatment are crucial in managing these patients. Combatting antibiotic resistance and adopting more complex treatment strategies are essential in the current management of cirrhotic patients.

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Summary: In this multicenter controlled trial, G-CSF did not show significant beneficial effects on ACLF patients compared to standard medical therapy alone. The study was terminated prematurely due to futility after analysis. Therefore, G-CSF should not be recommended as a standard treatment for ACLF.

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Summary: Acute-on-chronic liver failure syndrome involves liver function deterioration, extrahepatic organ failure, and high mortality rate, requiring rapid and coherent management in the intensive care unit to improve patient outcomes.

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EASL-CLIF criteria outperform NACSELD criteria for diagnosis and prognostication in ACLF

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Summary: This study compared the prevalence and 30-day mortality rates of patients with ACLF identified by the EASL-CLIF and NACSELD criteria, revealing significant discordance between the two. The EASL-CLIF criteria showed better sensitivity in detecting ACLF and had a better prognostic capability.

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Joan Claria et al.

Summary: This study focused on blood lipidomics in cirrhosis patients, revealing a generalized suppression of lipids in circulation. Specific lipid fingerprints were identified for distinguishing AD and ACLF, with liver dysfunction and infections playing key roles in their dynamics. Moreover, blood lysophosphatidylcholine levels increased in patients after albumin therapy.

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