PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis
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 mu...
| Authors: | ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; |
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| Format: | Article |
| Publication date: | 2021 |
| Country: | España |
| Institution: | Universitat Autònoma de Barcelona |
| Repository: | Dipòsit Digital de Documents de la UAB |
| Language: | English |
| OAI Identifier: | oai:ddd.uab.cat:272001 |
| Online Access: | https://ddd.uab.cat/record/272001 https://dx.doi.org/urn:doi:10.1016/j.jhep.2020.11.019 |
| Access Level: | Open access |
| Keyword: | Chronic liver disease Non-elective admission Acute complications Outcome Risk factors |
| _version_ | 1878733323792023552 |
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| author | Trebicka, Jonel|||0000-0002-7028-3881 |
| author2 | Fernández, Javier|||0000-0002-5622-0489 Papp, Maria|||0000-0003-3662-4010 Caraceni, Paolo|||0000-0002-1439-056X Laleman, Wim|||0000-0002-0842-7813 Gambino, Carmine|||0000-0001-9376-1527 Giovo, Ilaria|||0000-0002-6368-2964 Uschner, Frank Erhard Jansen, Christian Jiménez, Cesar|||0000-0003-2455-2048 Mookerjee, Rajeshwar Prosad|||0000-0002-6275-9384 Gustot, Thierry|||0000-0002-5537-9607 Albillos, Agustín|||0000-0001-9131-2592 Bañares, Rafael|||0000-0002-0412-8437 Jarcuska, Peter|||0000-0001-6169-9984 Steib, Christian|||0000-0002-4748-8248 Reiberger, Thomas|||0000-0002-4590-3583 Acevedo, Juan|||0000-0003-4507-2422 Gatti, Pietro|||0000-0003-0368-7509 Shawcross, Debbie|||0000-0001-6133-4619 Zeuzem, Stefan|||0000-0002-0845-6833 Zipprich, Alexander|||0000-0001-8403-7983 Piano, Salvatore|||0000-0002-9356-5830 Berg, Thomas|||0000-0003-0003-6241 Bruns, Tony|||0000-0002-5576-6914 Danielsen, Karen Vagner|||0000-0001-7194-4541 Coenraad, Minneke|||0000-0002-3434-4421 Merli, Manuela|||0000-0003-3173-9767 Stauber, Rudolf|||0000-0002-3687-9331 Zoller, Heinz|||0000-0003-1794-422X Presa Ramos, José Solé Martí, Cristina|||0000-0002-6104-8345 Soriano, German|||0000-0002-9267-6811 De Gottardi, Andrea|||0000-0002-4401-2340 Gronbaek, Henning|||0000-0001-8998-7910 Saliba, Faouzi|||0000-0002-2058-9217 Trautwein, Christian Kani, Haluk Tarik Francque, Sven|||0000-0002-7527-4714 Ryder, Stephen David|||0000-0001-9649-4444 Nahon, Pierre|||0000-0003-2489-0768 Romero-Gómez, Manuel|||0000-0001-8494-8947 Van Vlierberghe, Hans|||0000-0003-0647-9238 Francoz, Claire|||0000-0001-7391-8507 Manns, Michael|||0000-0002-4485-8856 Garcia-Lopez, Elisabet Tufoni, Manuel|||0000-0002-8588-193X Amoros, Alex Pavesi, Marco Sanchez, Cristina Praktiknjo, Michael|||0000-0001-7033-9956 Curto, Anna|||0000-0002-6625-3639 Pitarch, Carla|||0000-0002-6015-244X Putignano, Antonella|||0000-0002-4083-2405 Moreno, Esau Bernal, William|||0000-0002-6508-3287 Aguilar Parera, Ferran|||0000-0002-4367-8095 Claria, Joan|||0000-0003-4333-7749 Ponzo, Paola Vitalis, Zsuzsanna|||0000-0001-8198-5312 Zaccherini, Giacomo|||0000-0002-3219-6963 Balogh, Boglarka|||0000-0002-5670-1063 Gerbes, Alexander L.|||0000-0003-0440-7417 Vargas Blasco, Víctor|||0000-0002-7190-6948 Alessandria, Carlo|||0000-0001-5468-694X Bernardi, Mauro|||0000-0002-1308-5440 Ginès, Pere|||0000-0003-4657-4504 Moreau, Richard|||0000-0003-0862-403X Angeli, Paolo|||0000-0002-1913-0716 Jalan, Rajiv Arroyo, Vicente|||0000-0002-2728-1848 Maschmeier, Miriam Semela, David Elkrief, Laure|||0000-0003-2843-1710 Elsharkawy, Ahmed Tornai, Tamas Tornai, Istvan Altorjay, Istvan Antognoli, Agnese Baldassarre, Maurizio|||0000-0001-7865-394X Gagliardi, Martina Bertoli, Eleonora Mareso, Sara Brocca, Alessandra Campion, Daniela Saracco, Giorgio Maria|||0000-0001-5310-4143 Rizzo, Martina Lehmann, Jennifer Pohlmann, Alessandra Brol, Maximilian Joseph|||0000-0003-2879-7560 Chang, Johannes Schierwagen, Robert Solà, Elsa|||0000-0001-6897-2760 Amari, Nesrine Rodriguez, Miguel Nevens, Frederik|||0000-0003-2905-5112 Clemente, Ana Janicko, Martin|||0000-0002-3329-3968 Markwardt, Daniel Mandorfer, Mattias|||0000-0003-2330-0017 Welsch, Christoph Welzel, Tanja M. Ciraci, Emanuela Patel, Vish Ripoll, Cristina Herber, Adam Horn, Paul|||0000-0002-8755-7703 Bendtsen, Flemming Gluud, Lise Lotte|||0000-0002-9462-4468 Schaapman, Jelte Riggio, Oliviero Rainer, Florian Moritz, Jörg Tobiasch Mesquita, Mónica|||0000-0002-9490-7919 Alvarado-Tapias, Edilmar|||0000-0003-2036-6133 Akpata, Osagie Aamann, Luise Samuel, Didier Tresson, Sylvie Strnad, Pavel Amathieu, Roland Simón Talero, Macarena|||0000-0002-1409-3936 Smits, Francois van den Ende, Natalie Martinez González, Javier|||0000-0002-0094-7291 Garcia, Rita Rupprechter, Harald Engelmann, Cornelius Özdogan, Osman Cavit |
| author2_role | author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author |
| author_browse | Aamann, Luise Acevedo, Juan|||0000-0003-4507-2422 Aguilar Parera, Ferran|||0000-0002-4367-8095 Akpata, Osagie Albillos, Agustín|||0000-0001-9131-2592 Alessandria, Carlo|||0000-0001-5468-694X Altorjay, Istvan Alvarado-Tapias, Edilmar|||0000-0003-2036-6133 Amari, Nesrine Amathieu, Roland Amoros, Alex Angeli, Paolo|||0000-0002-1913-0716 Antognoli, Agnese Arroyo, Vicente|||0000-0002-2728-1848 Baldassarre, Maurizio|||0000-0001-7865-394X Balogh, Boglarka|||0000-0002-5670-1063 Bañares, Rafael|||0000-0002-0412-8437 Bendtsen, Flemming Berg, Thomas|||0000-0003-0003-6241 Bernal, William|||0000-0002-6508-3287 Bernardi, Mauro|||0000-0002-1308-5440 Bertoli, Eleonora Brocca, Alessandra Brol, Maximilian Joseph|||0000-0003-2879-7560 Bruns, Tony|||0000-0002-5576-6914 Campion, Daniela Caraceni, Paolo|||0000-0002-1439-056X Chang, Johannes Ciraci, Emanuela Claria, Joan|||0000-0003-4333-7749 Clemente, Ana Coenraad, Minneke|||0000-0002-3434-4421 Curto, Anna|||0000-0002-6625-3639 Danielsen, Karen Vagner|||0000-0001-7194-4541 De Gottardi, Andrea|||0000-0002-4401-2340 Elkrief, Laure|||0000-0003-2843-1710 Elsharkawy, Ahmed Engelmann, Cornelius Fernández, Javier|||0000-0002-5622-0489 Francoz, Claire|||0000-0001-7391-8507 Francque, Sven|||0000-0002-7527-4714 Gagliardi, Martina Gambino, Carmine|||0000-0001-9376-1527 Garcia, Rita Garcia-Lopez, Elisabet Gatti, Pietro|||0000-0003-0368-7509 Gerbes, Alexander L.|||0000-0003-0440-7417 Ginès, Pere|||0000-0003-4657-4504 Giovo, Ilaria|||0000-0002-6368-2964 Gluud, Lise Lotte|||0000-0002-9462-4468 Gronbaek, Henning|||0000-0001-8998-7910 Gustot, Thierry|||0000-0002-5537-9607 Herber, Adam Horn, Paul|||0000-0002-8755-7703 Jalan, Rajiv Janicko, Martin|||0000-0002-3329-3968 Jansen, Christian Jarcuska, Peter|||0000-0001-6169-9984 Jiménez, Cesar|||0000-0003-2455-2048 Kani, Haluk Tarik Laleman, Wim|||0000-0002-0842-7813 Lehmann, Jennifer Mandorfer, Mattias|||0000-0003-2330-0017 Manns, Michael|||0000-0002-4485-8856 Mareso, Sara Markwardt, Daniel Martinez González, Javier|||0000-0002-0094-7291 Maschmeier, Miriam Merli, Manuela|||0000-0003-3173-9767 Mesquita, Mónica|||0000-0002-9490-7919 Mookerjee, Rajeshwar Prosad|||0000-0002-6275-9384 Moreau, Richard|||0000-0003-0862-403X Moreno, Esau Moritz, Jörg Tobiasch Nahon, Pierre|||0000-0003-2489-0768 Nevens, Frederik|||0000-0003-2905-5112 Papp, Maria|||0000-0003-3662-4010 Patel, Vish Pavesi, Marco Piano, Salvatore|||0000-0002-9356-5830 Pitarch, Carla|||0000-0002-6015-244X Pohlmann, Alessandra Ponzo, Paola Praktiknjo, Michael|||0000-0001-7033-9956 Presa Ramos, José Putignano, Antonella|||0000-0002-4083-2405 Rainer, Florian Reiberger, Thomas|||0000-0002-4590-3583 Riggio, Oliviero Ripoll, Cristina Rizzo, Martina Rodriguez, Miguel Romero-Gómez, Manuel|||0000-0001-8494-8947 Rupprechter, Harald Ryder, Stephen David|||0000-0001-9649-4444 Saliba, Faouzi|||0000-0002-2058-9217 Samuel, Didier Sanchez, Cristina Saracco, Giorgio Maria|||0000-0001-5310-4143 Schaapman, Jelte Schierwagen, Robert Semela, David Shawcross, Debbie|||0000-0001-6133-4619 Simón Talero, Macarena|||0000-0002-1409-3936 Smits, Francois Solà, Elsa|||0000-0001-6897-2760 Solé Martí, Cristina|||0000-0002-6104-8345 Soriano, German|||0000-0002-9267-6811 Stauber, Rudolf|||0000-0002-3687-9331 Steib, Christian|||0000-0002-4748-8248 Strnad, Pavel Tornai, Istvan Tornai, Tamas Trautwein, Christian Trebicka, Jonel|||0000-0002-7028-3881 Tresson, Sylvie Tufoni, Manuel|||0000-0002-8588-193X Uschner, Frank Erhard Van Vlierberghe, Hans|||0000-0003-0647-9238 Vargas Blasco, Víctor|||0000-0002-7190-6948 Vitalis, Zsuzsanna|||0000-0001-8198-5312 Welsch, Christoph Welzel, Tanja M. Zaccherini, Giacomo|||0000-0002-3219-6963 Zeuzem, Stefan|||0000-0002-0845-6833 Zipprich, Alexander|||0000-0001-8403-7983 Zoller, Heinz|||0000-0003-1794-422X van den Ende, Natalie Özdogan, Osman Cavit |
| author_facet | Trebicka, Jonel|||0000-0002-7028-3881 Fernández, Javier|||0000-0002-5622-0489 Papp, Maria|||0000-0003-3662-4010 Caraceni, Paolo|||0000-0002-1439-056X Laleman, Wim|||0000-0002-0842-7813 Gambino, Carmine|||0000-0001-9376-1527 Giovo, Ilaria|||0000-0002-6368-2964 Uschner, Frank Erhard Jansen, Christian Jiménez, Cesar|||0000-0003-2455-2048 Mookerjee, Rajeshwar Prosad|||0000-0002-6275-9384 Gustot, Thierry|||0000-0002-5537-9607 Albillos, Agustín|||0000-0001-9131-2592 Bañares, Rafael|||0000-0002-0412-8437 Jarcuska, Peter|||0000-0001-6169-9984 Steib, Christian|||0000-0002-4748-8248 Reiberger, Thomas|||0000-0002-4590-3583 Acevedo, Juan|||0000-0003-4507-2422 Gatti, Pietro|||0000-0003-0368-7509 Shawcross, Debbie|||0000-0001-6133-4619 Zeuzem, Stefan|||0000-0002-0845-6833 Zipprich, Alexander|||0000-0001-8403-7983 Piano, Salvatore|||0000-0002-9356-5830 Berg, Thomas|||0000-0003-0003-6241 Bruns, Tony|||0000-0002-5576-6914 Danielsen, Karen Vagner|||0000-0001-7194-4541 Coenraad, Minneke|||0000-0002-3434-4421 Merli, Manuela|||0000-0003-3173-9767 Stauber, Rudolf|||0000-0002-3687-9331 Zoller, Heinz|||0000-0003-1794-422X Presa Ramos, José Solé Martí, Cristina|||0000-0002-6104-8345 Soriano, German|||0000-0002-9267-6811 De Gottardi, Andrea|||0000-0002-4401-2340 Gronbaek, Henning|||0000-0001-8998-7910 Saliba, Faouzi|||0000-0002-2058-9217 Trautwein, Christian Kani, Haluk Tarik Francque, Sven|||0000-0002-7527-4714 Ryder, Stephen David|||0000-0001-9649-4444 Nahon, Pierre|||0000-0003-2489-0768 Romero-Gómez, Manuel|||0000-0001-8494-8947 Van Vlierberghe, Hans|||0000-0003-0647-9238 Francoz, Claire|||0000-0001-7391-8507 Manns, Michael|||0000-0002-4485-8856 Garcia-Lopez, Elisabet Tufoni, Manuel|||0000-0002-8588-193X Amoros, Alex Pavesi, Marco Sanchez, Cristina Praktiknjo, Michael|||0000-0001-7033-9956 Curto, Anna|||0000-0002-6625-3639 Pitarch, Carla|||0000-0002-6015-244X Putignano, Antonella|||0000-0002-4083-2405 Moreno, Esau Bernal, William|||0000-0002-6508-3287 Aguilar Parera, Ferran|||0000-0002-4367-8095 Claria, Joan|||0000-0003-4333-7749 Ponzo, Paola Vitalis, Zsuzsanna|||0000-0001-8198-5312 Zaccherini, Giacomo|||0000-0002-3219-6963 Balogh, Boglarka|||0000-0002-5670-1063 Gerbes, Alexander L.|||0000-0003-0440-7417 Vargas Blasco, Víctor|||0000-0002-7190-6948 Alessandria, Carlo|||0000-0001-5468-694X Bernardi, Mauro|||0000-0002-1308-5440 Ginès, Pere|||0000-0003-4657-4504 Moreau, Richard|||0000-0003-0862-403X Angeli, Paolo|||0000-0002-1913-0716 Jalan, Rajiv Arroyo, Vicente|||0000-0002-2728-1848 Maschmeier, Miriam Semela, David Elkrief, Laure|||0000-0003-2843-1710 Elsharkawy, Ahmed Tornai, Tamas Tornai, Istvan Altorjay, Istvan Antognoli, Agnese Baldassarre, Maurizio|||0000-0001-7865-394X Gagliardi, Martina Bertoli, Eleonora Mareso, Sara Brocca, Alessandra Campion, Daniela Saracco, Giorgio Maria|||0000-0001-5310-4143 Rizzo, Martina Lehmann, Jennifer Pohlmann, Alessandra Brol, Maximilian Joseph|||0000-0003-2879-7560 Chang, Johannes Schierwagen, Robert Solà, Elsa|||0000-0001-6897-2760 Amari, Nesrine Rodriguez, Miguel Nevens, Frederik|||0000-0003-2905-5112 Clemente, Ana Janicko, Martin|||0000-0002-3329-3968 Markwardt, Daniel Mandorfer, Mattias|||0000-0003-2330-0017 Welsch, Christoph Welzel, Tanja M. Ciraci, Emanuela Patel, Vish Ripoll, Cristina Herber, Adam Horn, Paul|||0000-0002-8755-7703 Bendtsen, Flemming Gluud, Lise Lotte|||0000-0002-9462-4468 Schaapman, Jelte Riggio, Oliviero Rainer, Florian Moritz, Jörg Tobiasch Mesquita, Mónica|||0000-0002-9490-7919 Alvarado-Tapias, Edilmar|||0000-0003-2036-6133 Akpata, Osagie Aamann, Luise Samuel, Didier Tresson, Sylvie Strnad, Pavel Amathieu, Roland Simón Talero, Macarena|||0000-0002-1409-3936 Smits, Francois van den Ende, Natalie Martinez González, Javier|||0000-0002-0094-7291 Garcia, Rita Rupprechter, Harald Engelmann, Cornelius Özdogan, Osman Cavit |
| author_role | author |
| collection | Dipòsit Digital de Documents de la UAB |
| description | 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. |
| eu_rights_str_mv | openAccess |
| format | article |
| id | ES_5400aacef42a52448dda028fa7af004a |
| institution | Universitat Autònoma de Barcelona |
| instname_str | Universitat Autònoma de Barcelona |
| language | eng |
| network_acronym_str | ES |
| network_name_str | España |
| oai_identifier_str | oai:ddd.uab.cat:272001 |
| publishDate | 2021 |
| publishDateSort | 2021 |
| reponame_str | Dipòsit Digital de Documents de la UAB |
| spelling | PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis Trebicka, Jonel|||0000-0002-7028-3881 Fernández, Javier|||0000-0002-5622-0489 Papp, Maria|||0000-0003-3662-4010 Caraceni, Paolo|||0000-0002-1439-056X Laleman, Wim|||0000-0002-0842-7813 Gambino, Carmine|||0000-0001-9376-1527 Giovo, Ilaria|||0000-0002-6368-2964 Uschner, Frank Erhard Jansen, Christian Jiménez, Cesar|||0000-0003-2455-2048 Mookerjee, Rajeshwar Prosad|||0000-0002-6275-9384 Gustot, Thierry|||0000-0002-5537-9607 Albillos, Agustín|||0000-0001-9131-2592 Bañares, Rafael|||0000-0002-0412-8437 Jarcuska, Peter|||0000-0001-6169-9984 Steib, Christian|||0000-0002-4748-8248 Reiberger, Thomas|||0000-0002-4590-3583 Acevedo, Juan|||0000-0003-4507-2422 Gatti, Pietro|||0000-0003-0368-7509 Shawcross, Debbie|||0000-0001-6133-4619 Zeuzem, Stefan|||0000-0002-0845-6833 Zipprich, Alexander|||0000-0001-8403-7983 Piano, Salvatore|||0000-0002-9356-5830 Berg, Thomas|||0000-0003-0003-6241 Bruns, Tony|||0000-0002-5576-6914 Danielsen, Karen Vagner|||0000-0001-7194-4541 Coenraad, Minneke|||0000-0002-3434-4421 Merli, Manuela|||0000-0003-3173-9767 Stauber, Rudolf|||0000-0002-3687-9331 Zoller, Heinz|||0000-0003-1794-422X Presa Ramos, José Solé Martí, Cristina|||0000-0002-6104-8345 Soriano, German|||0000-0002-9267-6811 De Gottardi, Andrea|||0000-0002-4401-2340 Gronbaek, Henning|||0000-0001-8998-7910 Saliba, Faouzi|||0000-0002-2058-9217 Trautwein, Christian Kani, Haluk Tarik Francque, Sven|||0000-0002-7527-4714 Ryder, Stephen David|||0000-0001-9649-4444 Nahon, Pierre|||0000-0003-2489-0768 Romero-Gómez, Manuel|||0000-0001-8494-8947 Van Vlierberghe, Hans|||0000-0003-0647-9238 Francoz, Claire|||0000-0001-7391-8507 Manns, Michael|||0000-0002-4485-8856 Garcia-Lopez, Elisabet Tufoni, Manuel|||0000-0002-8588-193X Amoros, Alex Pavesi, Marco Sanchez, Cristina Praktiknjo, Michael|||0000-0001-7033-9956 Curto, Anna|||0000-0002-6625-3639 Pitarch, Carla|||0000-0002-6015-244X Putignano, Antonella|||0000-0002-4083-2405 Moreno, Esau Bernal, William|||0000-0002-6508-3287 Aguilar Parera, Ferran|||0000-0002-4367-8095 Claria, Joan|||0000-0003-4333-7749 Ponzo, Paola Vitalis, Zsuzsanna|||0000-0001-8198-5312 Zaccherini, Giacomo|||0000-0002-3219-6963 Balogh, Boglarka|||0000-0002-5670-1063 Gerbes, Alexander L.|||0000-0003-0440-7417 Vargas Blasco, Víctor|||0000-0002-7190-6948 Alessandria, Carlo|||0000-0001-5468-694X Bernardi, Mauro|||0000-0002-1308-5440 Ginès, Pere|||0000-0003-4657-4504 Moreau, Richard|||0000-0003-0862-403X Angeli, Paolo|||0000-0002-1913-0716 Jalan, Rajiv Arroyo, Vicente|||0000-0002-2728-1848 Maschmeier, Miriam Semela, David Elkrief, Laure|||0000-0003-2843-1710 Elsharkawy, Ahmed Tornai, Tamas Tornai, Istvan Altorjay, Istvan Antognoli, Agnese Baldassarre, Maurizio|||0000-0001-7865-394X Gagliardi, Martina Bertoli, Eleonora Mareso, Sara Brocca, Alessandra Campion, Daniela Saracco, Giorgio Maria|||0000-0001-5310-4143 Rizzo, Martina Lehmann, Jennifer Pohlmann, Alessandra Brol, Maximilian Joseph|||0000-0003-2879-7560 Chang, Johannes Schierwagen, Robert Solà, Elsa|||0000-0001-6897-2760 Amari, Nesrine Rodriguez, Miguel Nevens, Frederik|||0000-0003-2905-5112 Clemente, Ana Janicko, Martin|||0000-0002-3329-3968 Markwardt, Daniel Mandorfer, Mattias|||0000-0003-2330-0017 Welsch, Christoph Welzel, Tanja M. Ciraci, Emanuela Patel, Vish Ripoll, Cristina Herber, Adam Horn, Paul|||0000-0002-8755-7703 Bendtsen, Flemming Gluud, Lise Lotte|||0000-0002-9462-4468 Schaapman, Jelte Riggio, Oliviero Rainer, Florian Moritz, Jörg Tobiasch Mesquita, Mónica|||0000-0002-9490-7919 Alvarado-Tapias, Edilmar|||0000-0003-2036-6133 Akpata, Osagie Aamann, Luise Samuel, Didier Tresson, Sylvie Strnad, Pavel Amathieu, Roland Simón Talero, Macarena|||0000-0002-1409-3936 Smits, Francois van den Ende, Natalie Martinez González, Javier|||0000-0002-0094-7291 Garcia, Rita Rupprechter, Harald Engelmann, Cornelius Özdogan, Osman Cavit Chronic liver disease Non-elective admission Acute complications Outcome Risk factors 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. https://ddd.uab.cat/record/272001 https://dx.doi.org/urn:doi:10.1016/j.jhep.2020.11.019 |
| spellingShingle | PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis Trebicka, Jonel|||0000-0002-7028-3881 Chronic liver disease Non-elective admission Acute complications Outcome Risk factors |
| title | PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis |
| title_full | PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis |
| title_fullStr | PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis |
| title_full_unstemmed | PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis |
| title_short | PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis |
| title_sort | PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis |
| topic | Chronic liver disease Non-elective admission Acute complications Outcome Risk factors |
| topic_facet | Chronic liver disease Non-elective admission Acute complications Outcome Risk factors |
| url | https://ddd.uab.cat/record/272001 https://dx.doi.org/urn:doi:10.1016/j.jhep.2020.11.019 |