Acute-on-chronic liver failure in cirrhosis
The definition of acute-on-chronic liver failure (ACLF) remains contested. In Europe and North America, the term is generally applied according to the European Association for the Study of the Liver-Chronic Liver Failure (EASL-CLIF) Consortium guidelines, which defines this condition as a syndrome t...
| Authors: | ; ; ; ; ; ; ; ; ; |
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| Format: | Article |
| Status: | Accepted version |
| Publication date: | 2016 |
| Country: | España |
| Institution: | Universidad de Barcelona |
| Repository: | Dipòsit Digital de la UB |
| OAI Identifier: | oai:diposit.ub.edu:2445/128720 |
| Online Access: | https://hdl.handle.net/2445/128720 |
| Access Level: | Open access |
| Keyword: | Cirrosi hepàtica Malalties del fetge Complicacions (Medicina) Hepatic cirrhosis Liver diseases Complications (Medicine) |
| _version_ | 1878742006163832832 |
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| author | Arroyo, Vicente |
| author2 | Moreau, Richard Kamath, Patrick S. Jalan, Rajiv Ginès i Gibert, Pere Nevens, Frederick Fernández, Javier To, Uyen Garcia-Tsao, Guadalupe Schnabl, Bernd |
| author2_role | author author author author author author author author author |
| author_browse | Arroyo, Vicente Fernández, Javier Garcia-Tsao, Guadalupe Ginès i Gibert, Pere Jalan, Rajiv Kamath, Patrick S. Moreau, Richard Nevens, Frederick Schnabl, Bernd To, Uyen |
| author_facet | Arroyo, Vicente Moreau, Richard Kamath, Patrick S. Jalan, Rajiv Ginès i Gibert, Pere Nevens, Frederick Fernández, Javier To, Uyen Garcia-Tsao, Guadalupe Schnabl, Bernd |
| author_role | author |
| collection | Dipòsit Digital de la UB |
| description | The definition of acute-on-chronic liver failure (ACLF) remains contested. In Europe and North America, the term is generally applied according to the European Association for the Study of the Liver-Chronic Liver Failure (EASL-CLIF) Consortium guidelines, which defines this condition as a syndrome that develops in patients with cirrhosis and is characterized by acute decompensation, organ failure and high short-term mortality. One-third of patients who are hospitalized for acute decompensation present with ACLF at admission or develop the syndrome during hospitalization. ACLF frequently occurs in a closed temporal relationship to a precipitating event, such as bacterial infection or acute alcoholic, drug-induced or viral hepatitis. However, no precipitating event can be identified in approximately 40% of patients. The mechanisms of ACLF involve systemic inflammation due to infections, acute liver damage and, in cases without precipitating events, probably intestinal translocation of bacteria or bacterial products. ACLF is graded into three stages (ACLF grades 1-3) on the basis of the number of organ failures, with higher grades associated with increased mortality. Liver and renal failures are the most common organ failures, followed by coagulation, brain, circulatory and respiratory failure. The 28-day mortality rate associated with ACLF is 30%. Depending on the grade, ACLF can be reversed using standard therapy in only 16-51% of patients, leaving a considerable proportion of patients with ACLF that remains steady or progresses. Liver transplantation in selected patients with ACLF grade 2 and ACLF grade 3 increases the 6-month survival from 10% to 80%. |
| eu_rights_str_mv | openAccess |
| format | article |
| id | ES_eea7098e73e2bbf2a70c007cda08bbdd |
| institution | Universidad de Barcelona |
| instname_str | Universidad de Barcelona |
| network_acronym_str | ES |
| network_name_str | España |
| oai_identifier_str | oai:diposit.ub.edu:2445/128720 |
| publishDate | 2016 |
| publishDateSort | 2016 |
| publisher | Nature Publishing Group |
| publisherStr | Nature Publishing Group |
| reponame_str | Dipòsit Digital de la UB |
| spelling | Acute-on-chronic liver failure in cirrhosis Arroyo, Vicente Moreau, Richard Kamath, Patrick S. Jalan, Rajiv Ginès i Gibert, Pere Nevens, Frederick Fernández, Javier To, Uyen Garcia-Tsao, Guadalupe Schnabl, Bernd Cirrosi hepàtica Malalties del fetge Complicacions (Medicina) Hepatic cirrhosis Liver diseases Complications (Medicine) The definition of acute-on-chronic liver failure (ACLF) remains contested. In Europe and North America, the term is generally applied according to the European Association for the Study of the Liver-Chronic Liver Failure (EASL-CLIF) Consortium guidelines, which defines this condition as a syndrome that develops in patients with cirrhosis and is characterized by acute decompensation, organ failure and high short-term mortality. One-third of patients who are hospitalized for acute decompensation present with ACLF at admission or develop the syndrome during hospitalization. ACLF frequently occurs in a closed temporal relationship to a precipitating event, such as bacterial infection or acute alcoholic, drug-induced or viral hepatitis. However, no precipitating event can be identified in approximately 40% of patients. The mechanisms of ACLF involve systemic inflammation due to infections, acute liver damage and, in cases without precipitating events, probably intestinal translocation of bacteria or bacterial products. ACLF is graded into three stages (ACLF grades 1-3) on the basis of the number of organ failures, with higher grades associated with increased mortality. Liver and renal failures are the most common organ failures, followed by coagulation, brain, circulatory and respiratory failure. The 28-day mortality rate associated with ACLF is 30%. Depending on the grade, ACLF can be reversed using standard therapy in only 16-51% of patients, leaving a considerable proportion of patients with ACLF that remains steady or progresses. Liver transplantation in selected patients with ACLF grade 2 and ACLF grade 3 increases the 6-month survival from 10% to 80%. Nature Publishing Group https://hdl.handle.net/2445/128720 |
| spellingShingle | Acute-on-chronic liver failure in cirrhosis Arroyo, Vicente Cirrosi hepàtica Malalties del fetge Complicacions (Medicina) Hepatic cirrhosis Liver diseases Complications (Medicine) |
| status_str | acceptedVersion |
| title | Acute-on-chronic liver failure in cirrhosis |
| title_full | Acute-on-chronic liver failure in cirrhosis |
| title_fullStr | Acute-on-chronic liver failure in cirrhosis |
| title_full_unstemmed | Acute-on-chronic liver failure in cirrhosis |
| title_short | Acute-on-chronic liver failure in cirrhosis |
| title_sort | Acute-on-chronic liver failure in cirrhosis |
| topic | Cirrosi hepàtica Malalties del fetge Complicacions (Medicina) Hepatic cirrhosis Liver diseases Complications (Medicine) |
| topic_facet | Cirrosi hepàtica Malalties del fetge Complicacions (Medicina) Hepatic cirrhosis Liver diseases Complications (Medicine) |
| url | https://hdl.handle.net/2445/128720 |