 visitant ::
identificació
|
|||||||||||||||
|
Cerca | Lliura | Ajuda | Servei de Biblioteques | Sobre el DDD | Català English Español | |||||||||
| Pàgina inicial > Articles > Articles publicats > PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis |
(Department of Internal Medicine I. Goethe University Frankfurt) (Institut d'Investigacions Biomèdiques August Pi i Sunyer) (University of Debrecen. Faculty of Medicine. Institute of Medicine. Department of Gastroenterology) (University of Bologna) (University of Leuven) (University of Padova) (A.O.U. Città della Salute e della Scienza Torino) (UCL Medical School. Royal Free Hospital) (C.U.B. Erasme) (Hospital Universitario Ramón y Cajal (Madrid)) (Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)) (Pavol Jozef Safarik University in Kosice) (Department of Medicine II. Liver Centre Munich. University Hospital. LMU) (Medical University of Vienna) (University Hospitals Plymouth NHS Trust (Regne Unit)) (Internal Medicine PO Ostuni) (King's College Hospital NHS Foundation Trust) (Department of Internal Medicine I. Goethe University Frankfurt) (University Hospital Halle-Wittenberg) (University of Padova) (Aachen University Hospital) (University of Copenhagen) (Leiden University Medical Center) (Universitá Sapienza Roma) (Medical University of Graz) (Medical University of Innsbruck) (Institut d'Investigacions Biomèdiques August Pi i Sunyer) (Institut d'Investigació Biomèdica Sant Pau) (University Clinic of Visceral Surgery and Medicine-Inselspital. Bern and Ente Ospedaliero Cantonale. Universita della Svizzera Italiana) (Aarhus University Hospital (Aarhus, Dinamarca)) (AP-HP Hôpital Paul Brousse. Centre Hépato-Biliaire. Universite Paris Saclay. INSERM Unit 1193) (University Hospital Antwerp) (NIHR Biomedical Research Centre at Nottingham University Hospitals NHS Trust and the University of Nottingham) (Inserm. UMR-1162. "Génomique fonctionnelle des tumeurs solides") (Universitair Ziekenhuis Gent) (Inserm. Université de Paris. Centre de Recherche sur L'Inflammation) (Hannover Medical School) (University of Bologna) (Department of Internal Medicine I. University Hospital Bonn) (European Foundation for Study of Chronic Liver Failure. EF-Clif) (European Foundation for Study of Chronic Liver Failure. EF-Clif) (C.U.B. Erasme) (King's College Hospital NHS Foundation Trust) (European Foundation for Study of Chronic Liver Failure. EF-Clif) (Institut d'Investigacions Biomèdiques August Pi i Sunyer) (University of Debrecen. Faculty of Medicine. Institute of Medicine. Department of Gastroenterology) (University of Bologna) (University of Debrecen. Faculty of Medicine. Institute of Medicine. Department of Gastroenterology) (Department of Medicine II. Liver Centre Munich. University Hospital. LMU) (A.O.U. Città della Salute e della Scienza Torino) (University of Bologna) (Institut d'Investigacions Biomèdiques August Pi i Sunyer) (Inserm. Université de Paris. Centre de Recherche sur L'Inflammation) (University of Padova) (European Foundation for Study of Chronic Liver Failure. EF-Clif) (Hôpitaux Universitaires de Genève) (University of Bologna) (A.O.U. Città della Salute e della Scienza Torino) (University Hospital Bonn (Bonn, Alemanya)) (University Hospital Bonn (Bonn, Alemanya)) (Hospital Clínic i Provincial de Barcelona) (Pavol Jozef Safarik University in Kosice) (Medical University of Vienna) (University Hospital Halle-Wittenberg) (Jena University Hospital (Alemanya)) (Gastrounit. Medical Section. Hvidovre Hospital and Department of Clinical Medicine. University of Copenhagen) (Institut d'Investigació Biomèdica Sant Pau)| Data: | 2021 |
| Resum: | Background & Aims: Acute decompensation (AD) of cirrhosis may present without acute-on-chronic liver failure (ACLF) (AD-No ACLF), or with ACLF (AD-ACLF), defined by organ failure(s). Herein, we aimed to analyze and characterize the precipitants leading to both of these AD phenotypes. Methods: The multicenter, prospective, observational PREDICT study (NCT03056612) included 1,273 non-electively hospitalized patients with AD (No ACLF = 1,071; ACLF = 202). Medical history, clinical data and laboratory data were collected at enrolment and during 90-day follow-up, with particular attention given 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, 4 distinct events were precipitants consistently related to AD: proven bacterial infections, severe alcoholic hepatitis, gastrointestinal 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. Survival was similar in patients with proven bacterial infections or severe alcoholic hepatitis in both AD phenotypes. 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 a 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 in patients with AD. Specific preventive and therapeutic strategies targeting these events may improve outcomes in patients with decompensated cirrhosis. Lay summary: Acute decompensation (AD) of cirrhosis is characterized by a rapid deterioration in patient health. Herein, we aimed to analyze the precipitating events that cause AD in patients with cirrhosis. Proven bacterial infections and severe alcoholic hepatitis, either alone or in combination, accounted for almost all (96-97%) cases of AD and acute-on-chronic liver failure. Whilst the type of precipitant was not associated with mortality, the number of precipitant(s) was. This study identified precipitants that are significantly associated with a distinct clinical course and prognosis of patients with AD. Specific preventive and therapeutic strategies targeting these events may improve patient outcomes. |
| Nota: | Altres ajuts: European Foundation for the Study of Chronic Liver Failure (EF-Clif). |
| Drets: | Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.  |
| Llengua: | Anglès |
| Document: | Article ; recerca ; Versió publicada |
| Matèria: | Chronic liver disease ; Non-elective admission ; Acute complications ; Outcome ; Risk factors |
| Publicat a: | Journal of Hepatology, Vol. 74 Núm. 5 (may 2021) , p. 1097-1108, ISSN 1600-0641 |
