The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology
Por:
Trebicka, J, Fernandez, J, Papp, M, Caraceni, P, Laleman, W, Gambino, C, Giovo, I, Uschner, FE, Jimenez, C, Mookerjee, R, Gustot, T, Albillos, A, Banares, R, Janicko, M, Steib, C, Reiberger, T, Acevedo, J, Gatti, P, Bernal, W, Zeuzem, S, Zipprich, A, Piano, S, Berg, T, Bruns, T, Bendtsen, F, Coenraad, M, Merli, M, Stauber, R, Zoller, H, Ramos, JP, Sole, C, Soriano, G, de Gottardi, A, Gronbaek, H, Saliba, F, Trautwein, C, Ozdogan, OC, Francque, S, Ryder, S, Nahon, P, Romero-Gomez, M, Van Vlierberghe, H, Francoz, C, Manns, M, Garcia, E, Tufoni, M, Amoros, A, Pavesi, M, Sanchez, C, Curto, A, Pitarch, C, Putignano, A, Moreno, E, Shawcross, D, Aguilar, F, Claria, J, Ponzo, P, Jansen, C, Vitalis, Z, Zaccherini, G, Balogh, B, Vargas, V, Montagnese, S, Alessandria, C, Bernardi, M, Gines, P, Jalan, R, Moreau, R, Angeli, P, Arroyo, V, PREDICT STUDY Group, EASL-CLIF Consortium
Publicada:
1 ago 2020
Resumen:
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.
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. (C) 2020 European Association for the Study of the Liver. Published by Elsevier B.V.
Filiaciones:
Trebicka, J:
European Fdn Study Chron Liver Failure, EF Clif, Travesera Gracia 11,7th Floor, Barcelona 08021, Spain
JW Goethe Univ Hosp, Frankfurt, Germany
Fernandez, J:
European Fdn Study Chron Liver Failure, EF Clif, Travesera Gracia 11,7th Floor, Barcelona 08021, Spain
Hosp Clin Barcelona, IDIBAPS, Barcelona, Spain
Hosp Clin Barcelona, CIBEehd, Barcelona, Spain
Papp, M:
Univ Debrecen, Fac Med, Inst Med, Dept Gastroenterol, Debrecen, Hungary
Caraceni, P:
Univ Bologna, Bologna, Italy
Laleman, W:
Univ Leuven, Leuven, Belgium
Gambino, C:
Univ Padua, Dept Med, Padua, Italy
Giovo, I:
Univ Torino, Citta Salute & Sci Hosp, Div Gastroenterol & Hepatol, Turin, Italy
Uschner, FE:
JW Goethe Univ Hosp, Frankfurt, Germany
Jimenez, C:
Univ Autonoma Barcelona, Hosp Vall Hebron, Liver Unit, CIBEREHD, Barcelona, Spain
Mookerjee, R:
UCL Med Sch, Royal Free Hosp, London, England
Gustot, T:
Univ Libre Bruxelles, Brussels, Belgium
Albillos, A:
Univ Alcala De Henares, Hosp Univ Ramon Y Cajal, Dept Gastroenterol, CIBEREHD,IRYCIS, Madrid, Spain
Banares, R:
Univ Complutense, Hosp Gen Univ Gregorio Maranon, Fac Med, Gastroenterol & Hepatol Dept,CIBERehd, Madrid, Spain
Janicko, M:
Pavol Jozef Safarik Univ Kosice, Kosice, Slovakia
Steib, C:
Univ Hosp Munich, Dept Med 2, Munich, Germany
Reiberger, T:
Med Univ Vienna, Vienna, Austria
Acevedo, J:
Univ Hosp Plymouth NHS Trust, Plymouth, Devon, England
Gatti, P:
ASL Brindisi, Intemal Med PO Ostuni, Brindisi, Italy
Bernal, W:
Kings Coll Hosp London, London, England
Zeuzem, S:
JW Goethe Univ Hosp, Frankfurt, Germany
Zipprich, A:
Univ Hosp Halle Wittenberg, Halle, Saale, Germany
Piano, S:
Univ Padua, Dept Med, Padua, Italy
Berg, T:
Univ Leipzig, Med Ctr, Dept Med 2, Div Hepatol, Leipzig, Germany
Bruns, T:
Jena Univ Hosp, Jena, Germany
Aachen Univ Hosp, Aachen, Germany
Bendtsen, F:
Hvidovre Univ Hosp, Hvidovre, Denmark
Coenraad, M:
Leiden Univ, Med Ctr, Leiden, Netherlands
Merli, M:
Univ Sapienza Roma, Dept Translat & Precis Med, Rome, Italy
Stauber, R:
Med Univ Graz, Graz, Austria
Zoller, H:
Med Univ Innsbruck, Innsbruck, Austria
Ramos, JP:
CHTMAD Vila Real, Vila Real, Portugal
Sole, C:
Hosp Clin Barcelona, IDIBAPS, Barcelona, Spain
Hosp Clin Barcelona, CIBEehd, Barcelona, Spain
Soriano, G:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
CIBEREHD, Barcelona, Spain
de Gottardi, A:
Univ Clin Visceral Surg & Med Inselspital, Bern, Switzerland
Univ Svizzera Italiana, Ente Ospedaliero Cantonale, Lugano, Switzerland
Gronbaek, H:
Aarhus Univ Hosp, Aarhus, Denmark
Saliba, F:
Univ Paris Saclay, Ctr Hepatobiliaire, INSERM Unit 1193, AP HP Hop Paul Brousse, Villejuif, France
Trautwein, C:
Aachen Univ Hosp, Aachen, Germany
Ozdogan, OC:
Marmara Univ, Istanbul, Turkey
Francque, S:
Univ Hosp Antwerp, Antwerp, Belgium
Ryder, S:
Nottingham Univ Hosp NHS Trus, NIHR Biomed Res Ctr, Nottingham, England
Univ Nottingham, Nottingham, England
Nahon, P:
Hop Jean Verdier, Serv Hepatol, AP HP, Bondy, France
Univ Paris 13, Sorbonne Paris Cite, Equipe Labellisee Ligue Canc, St Denis, France
INSERM, UMR 1162, Genom Fonct Tumeurs Sondes, Paris, France
Romero-Gomez, M:
Virgen Rocio Univ Hosp, Seville, Spain
Van Vlierberghe, H:
Ghent Univ Hosp, Ghent, Belgium
Francoz, C:
Hop Beaujon, Serv Hepatol, APHP, Clichy, France
Univ Paris, Ctr Rech LInflammat, INSERM, Paris, France
Manns, M:
Hannover Med Sch, Hannover, Germany
Garcia, E:
European Fdn Study Chron Liver Failure, EF Clif, Travesera Gracia 11,7th Floor, Barcelona 08021, Spain
Tufoni, M:
Univ Bologna, Bologna, Italy
Amoros, A:
European Fdn Study Chron Liver Failure, EF Clif, Travesera Gracia 11,7th Floor, Barcelona 08021, Spain
Pavesi, M:
European Fdn Study Chron Liver Failure, EF Clif, Travesera Gracia 11,7th Floor, Barcelona 08021, Spain
Sanchez, C:
European Fdn Study Chron Liver Failure, EF Clif, Travesera Gracia 11,7th Floor, Barcelona 08021, Spain
Curto, A:
European Fdn Study Chron Liver Failure, EF Clif, Travesera Gracia 11,7th Floor, Barcelona 08021, Spain
Pitarch, C:
European Fdn Study Chron Liver Failure, EF Clif, Travesera Gracia 11,7th Floor, Barcelona 08021, Spain
Putignano, A:
Univ Libre Bruxelles, Brussels, Belgium
Moreno, E:
European Fdn Study Chron Liver Failure, EF Clif, Travesera Gracia 11,7th Floor, Barcelona 08021, Spain
Shawcross, D:
Kings Coll Hosp London, London, England
Aguilar, F:
European Fdn Study Chron Liver Failure, EF Clif, Travesera Gracia 11,7th Floor, Barcelona 08021, Spain
Claria, J:
European Fdn Study Chron Liver Failure, EF Clif, Travesera Gracia 11,7th Floor, Barcelona 08021, Spain
Hosp Clin Barcelona, IDIBAPS, Barcelona, Spain
Hosp Clin Barcelona, CIBEehd, Barcelona, Spain
Ponzo, P:
Univ Torino, Citta Salute & Sci Hosp, Div Gastroenterol & Hepatol, Turin, Italy
Jansen, C:
Univ Hosp Bonn, Bonn, Germany
Vitalis, Z:
Univ Debrecen, Fac Med, Inst Med, Dept Gastroenterol, Debrecen, Hungary
Zaccherini, G:
Univ Bologna, Bologna, Italy
Balogh, B:
Univ Debrecen, Fac Med, Inst Med, Dept Gastroenterol, Debrecen, Hungary
Vargas, V:
Univ Autonoma Barcelona, Hosp Vall Hebron, Liver Unit, CIBEREHD, Barcelona, Spain
Montagnese, S:
Univ Padua, Dept Med, Padua, Italy
Alessandria, C:
Univ Torino, Citta Salute & Sci Hosp, Div Gastroenterol & Hepatol, Turin, Italy
Bernardi, M:
Univ Bologna, Bologna, Italy
Gines, P:
Hosp Clin Barcelona, IDIBAPS, Barcelona, Spain
Hosp Clin Barcelona, CIBEehd, Barcelona, Spain
Jalan, R:
European Fdn Study Chron Liver Failure, EF Clif, Travesera Gracia 11,7th Floor, Barcelona 08021, Spain
UCL Med Sch, Royal Free Hosp, London, England
Moreau, R:
European Fdn Study Chron Liver Failure, EF Clif, Travesera Gracia 11,7th Floor, Barcelona 08021, Spain
Hop Beaujon, Serv Hepatol, APHP, Clichy, France
Univ Paris, Ctr Rech LInflammat, INSERM, Paris, France
Angeli, P:
European Fdn Study Chron Liver Failure, EF Clif, Travesera Gracia 11,7th Floor, Barcelona 08021, Spain
Univ Padua, Dept Med, Padua, Italy
Green Published, Hybrid Gold, Green Accepted
|