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Title: The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology
Author: Trebicka, Jonel
Fernández, Javier
Papp, Maria
Caraceni, Paolo
Laleman, Wim
Gambino, Carmine
Giovo, Ilaria
Uschner, Frank Erhard
Jiménez, César
Mookerjee, Rajeshwar P.
Gustot, Thierry
Albillos, Agustín
Bañares, Rafael
Janicko, Martin
Steib, Christian
Reiberger, Thomas
Acevedo, Juan
Gatti, Pietro
Bernal, William
Zeuzem, Stefan
Zipprich, Alexander
Piano, Salvatore
Berg, Thomas
Bruns, Tony
Bendtsen, Flemming
Coenraad, Minneke J.
Merli, Manuela
Stauber, Rudolf
Zoller, Heinz
Presa Ramos, José
Solé Padullés, Cristina
Soriano Pastor, Germán
de Gottardi, Andrea
Gronbaek, Henning
Saliba, Faouzi
Trautwein, Christian
Özdogan, Osman Cavit
Francque, Sven
Ryder, Stephen
Nahon, Pierre
Romero-Gomez, Manuel
Vlierberghe, Hans Van
Francoz, Claire
Manns, Michael
Garcia, Elisabet
Tufoni, Manuel
Amorós, Àlex
Pavesi, Marco
Sanchez, Cristina
Curto, Anna
Pitarch, Carla
Putignano, Antonella
Moreno, Esau
Shawcross, Debbie
Aguilar, Ferran
Clària i Enrich, Joan
Ponzo, Paola
Jansen, Christian
Vitalis, Zsuzsanna
Zaccherini, Giacomo
Balogh, Boglarka
Vargas, Víctor
Montagnese, Sara
Alessandria, Carlo
Bernardi, Mauro
Ginès i Gibert, Pere
Jalan, Rajiv
Moreau, Richard
Angeli, Paolo
Arroyo, Vicente
Keywords: Cirrosi hepàtica
Hemorràgia gastrointestinal
Trasplantament hepàtic
Hepatic cirrhosis
Gastrointestinal hemorrhage
Hepatic transplantation
Issue Date: 13-Jul-2020
Publisher: Elsevier
Abstract: Background & aims: Acute decompensation (AD) of cirrhosis is defined as the acute development of ascites, gastrointestinal hemorrhage, hepatic encephalopathy, infection or any combination thereof, requiring hospitalization. The presence of organ failure(s) in patients with AD defines acute-on-chronic liver failure (ACLF). The PREDICT study is a European, prospective, observational study, designed to characterize the clinical course of AD and to identify predictors of ACLF. Methods: A total of 1,071 patients with AD were enrolled. We collected detailed pre-specified information on the 3-month period prior to enrollment, and clinical and laboratory data at enrollment. Patients were then closely followed up for 3 months. Outcomes (liver transplantation and death) at 1 year were also recorded. Results: Three groups of patients were identified. Pre-ACLF patients (n = 218) developed ACLF and had 3-month and 1-year mortality rates of 53.7% and 67.4%, respectively. Unstable decompensated cirrhosis (UDC) patients (n = 233) required ≥1 readmission but did not develop ACLF and had mortality rates of 21.0% and 35.6%, respectively. Stable decompensated cirrhosis (SDC) patients (n = 620) were not readmitted, did not develop ACLF and had a 1-year mortality rate of only 9.5%. The 3 groups differed significantly regarding the grade and course of systemic inflammation (high-grade at enrollment with aggravation during follow-up in pre-ACLF; low-grade at enrollment with subsequent steady-course in UDC; and low-grade at enrollment with subsequent improvement in SDC) and the prevalence of surrogates of severe portal hypertension throughout the study (high in UDC vs. low in pre-ACLF and SDC). Conclusions: Acute decompensation without ACLF is a heterogeneous condition with 3 different clinical courses and 2 major pathophysiological mechanisms: systemic inflammation and portal hypertension. Predicting the development of ACLF remains a major future challenge. CLINICALTRIALS. Lay summary: Herein, we describe, for the first time, 3 different clinical courses of acute decompensation (AD) of cirrhosis after hospital admission. The first clinical course includes patients who develop acute-on-chronic liver failure (ACLF) and have a high short-term risk of death - termed pre-ACLF. The second clinical course (unstable decompensated cirrhosis) includes patients requiring frequent hospitalizations unrelated to ACLF and is associated with a lower mortality risk than pre-ACLF. Finally, the third clinical course (stable decompensated cirrhosis), includes two-thirds of all patients admitted to hospital with AD - patients in this group rarely require hospital admission and have a much lower 1-year mortality risk.
Note: Reproducció del document publicat a:
It is part of: Journal of Hepatology, 2020, vol. 73, num. 4, p. 842-854
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ISSN: 0168-8278
Appears in Collections:Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)
Articles publicats en revistes (Medicina)

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