Anàlisi de l’expressió inflamatòria i la supervivència dels pacients cirròtics

Abstract

(cat) La cirrosi hepàtica es pot presentar de forma compensada o descompensada, caracteritzant-se aquesta última per l’aparició d’alguna complicació com ascites, encefalopatia hepàtica, hemorràgia gastrointestinal i/o infecció bacteriana. En cirrosi descompensada, és freqüent el desenvolupament de la síndrome Acute-on-Chronic Liver Failure (ACLF), definida per la presència d’insuficiències i disfuncions orgàniques i una elevada taxa de mortalitat a curt termini. Recentment, s’ha trobat que el desenvolupament del mecanisme d’inflamació sistèmica té un rol rellevant en els pacients que pateixen ACLF. L’objectiu de la present investigació, és estudiar el patró d’expressió inflamatòria dels pacients cirròtics en funció de la presència de possibles complicacions orgàniques, així com la mortalitat, considerant la mort com a esdeveniment principal i el trasplantament de fetge com a esdeveniment competitiu.

(eng) Liver cirrhosis is a degenerative disease caused by the deterioration of healthy liver tissue and may be either compensated or decompensated, characterized the latter by the development of large ascites, hepatic encephalopathy, gastrointestinal hemorrhage, bacterial infection, or any combination of them. In the context of decompensated cirrhosis, the development of the syndrome known as Acute-on-Chronic Liver Failure (ACLF) is common. The syndrome is defined by the presence of organ dysfunctions and organ failures and high short-term mortality. Patients with decompensated cirrhosis without ACLF may have a single liver failure, while ACLF is defined by the occurrence of a single renal failure, single non-renal failure (liver, coagulation, circulation, respiration) associated with organ dysfunction (renal/cerebral) or patients with more than one failure. Recently, it has been found that the development of the systemic inflammation mechanism has a relevant role in ACLF patients. The first aim of the present investigation is to study the inflammatory expression pattern in a sample of 582 healthy, compensated, decompensated and ACLF patients, depending on the presence of possible organ complications. Commonly, cirrhotic patients need to receive a liver transplant which modifies their probability of dying. Because of this, the second objective of this project is to assess their mortality considering death as a primary event and liver transplant as a competitive event and quantify the risk of death of decompensated and ACLF patients according to the development of organ dysfunctions and organ failures. The results show a clear association between worsening hepatic cirrhosis, along with the manifestation of organic complications, and accentuation of inflammation. Moreover, there is evidence that ACLF patients have a higher risk of dying than the decompensated individuals without ACLF, being the probability of dying from the two groups of 37% and 16%, respectively. In addition, there is no certainty that the development of organ dysfunction or organ failure in decompensated cirrhotic patients leads to an increase in the risk of death.