Trebicka, Jonel; Fernandez, Javier; Papp, Maria; Caraceni, Paolo; Laleman, Wim; Gambino, Carmine; Giovo, Ilaria; Uschner, Frank Erhard; Jansen, Christian; Jimenez, Cesar; Mookerjee, Rajeshwar; Gustot, Thierry; Albillos, Agustin; Bañares, Rafael; Jarcuska, Peter; Steib, Christian; Reiberger, Thomas; Acevedo, Juan; Gatti, Pietro; Shawcross, Debbie L; ... (2021). PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis. Journal of hepatology, 74(5), pp. 1097-1108. Elsevier 10.1016/j.jhep.2020.11.019
|
Text
1-s2.0-S0168827820337727-main.pdf - Accepted Version Available under License Creative Commons: Attribution-Noncommercial-No Derivative Works (CC-BY-NC-ND). Download (8MB) | Preview |
INTRODUCTION
Acute decompensation (AD) of cirrhosis may present without acute-on-chronic liver failure (ACLF) (AD-No ACLF), or with ACLF phenotype (AD-ACLF) defined by organ failure(s). Precipitants may induce AD. This multicenter, prospective, observational PREDICT study (NCT03056612) analyzes and characterizes the precipitants leading to both of these AD phenotypes.
PATIENTS AND METHODS
The PREDICT study included 1273 non-electively hospitalized patients with AD (No-ACLF=1071; ACLF=202). Medical history, clinical and laboratory data were collected at enrolment and during 90-day follow up, with particular attention to the following characteristics of precipitants: induction of organ dysfunction or failure, systemic inflammation, chronology, intensity, and relationship to outcome.
RESULTS
Among various clinical events, four distinct events were precipitants consistently related to AD, including proven bacterial infections, severe alcoholic hepatitis, gastrointestinal (GI) bleeding with shock and toxic encephalopathy. Among patients with precipitants in the AD-No ACLF cohort and the AD-ACLF cohort (38% and 71%, respectively), almost all (96% and 97%, respectively) showed proven bacterial infection and severe alcoholic hepatitis, either alone or in combination with other events. In both AD phenotypes, patients with proven bacterial infections or severe alcoholic hepatitis had a similar survival. The number of precipitants was associated with significantly increased 90-day mortality, and was paralleled by increasing levels of surrogates for systemic inflammation. Importantly, adequate first-line antibiotic treatment of proven bacterial infections was associated with lower ACLF development rate and lower 90-day mortality.
CONCLUSIONS
This study identified precipitants that are significantly associated with a distinct clinical course and prognosis of patients with AD and specific preventive and therapeutic strategies targeting these events may improve outcome in decompensated cirrhosis.
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Hepatology |
UniBE Contributor: |
De Gottardi, Andrea |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
0168-8278 |
Publisher: |
Elsevier |
Language: |
English |
Submitter: |
Thi Thao Anh Pham |
Date Deposited: |
07 Jan 2021 10:37 |
Last Modified: |
05 Dec 2022 15:43 |
Publisher DOI: |
10.1016/j.jhep.2020.11.019 |
PubMed ID: |
33227350 |
Uncontrolled Keywords: |
acute complications chronic liver disease non-elective admission outcome risk factors |
BORIS DOI: |
10.48350/149883 |
URI: |
https://boris.unibe.ch/id/eprint/149883 |
Actions (login required)
 |
Edit item |