PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis
Por:
Trebicka, J, Fernandez, J, Papp, M, Caraceni, P, Laleman, W, Gambino, C, Giovo, I, Uschner, FE, Jansen, C, Jimenez, C, Mookerjee, R, Gustot, T, Albillos, A, Banares, R, Jarcuska, P, Steib, C, Reiberger, T, Acevedo, J, Gatti, P, Shawcross, DL, Zeuzem, S, Zipprich, A, Piano, S, Berg, T, Bruns, T, Danielsen, KV, Coenraad, M, Merli, M, Stauber, R, Zoller, H, Ramos, JP, Sole, C, Soriano, G, De Gottardi, A, Gronbaek, H, Saliba, F, Trautwein, C, Kani, HT, Francque, S, Ryder, S, Nahon, P, Romero-Gomez, M, Van Vlierberghe, H, Francoz, C, Manns, M, Garcia-Lopez, E, Tufoni, M, Amoros, A, Pavesi, M, Sanchez, C, Praktiknjo, M, Curto, A, Pitarch, C, Putignano, A, Moreno, E, Bernal, W, Aguilar, F, Claria, J, Ponzo, P, Vitalis, Z, Zaccherini, G, Balogh, B, Gerbes, A, Vargas, V, Alessandria, C, Bernardi, M, Gines, P, Moreau, R, Angeli, P, Jalan, R, Arroyo, V, Maschmeier, M, Semela, D, Elkrief, L, Elsharkawy, A, Tornai, T, Tornai, I, Altorjay, I, Antognoli, A, Baldassarre, M, Gagliardi, M, Bertoli, E, Mareso, S, Brocca, A, Campion, D, Saracco, GM, Rizzo, M, Lehmann, J, Pohlmann, A, Brol, MJ, Chang, J, Schierwagen, R, Sola, E, Amari, N, Rodriguez, M, Nevens, F, Clemente, A, Janicko, M, Markwardt, D, Mandorfer, M, Welsch, C, Welzel, TM, Ciraci, E, Patel, V, Ripoll, C, Herber, A, Horn, P, Bendtsen, F, Gluud, LL, Schaapman, J, Riggio, O, Rainer, F, Moritz, JT, Mesquita, M, Alvarado-Tapias, E, Akpata, O, Aamann, L, Samuel, D, Tresson, S, Strnad, P, Amathieu, R, Simon-Talero, M, Smits, F, Van den Ende, N, Martinez, J, Garcia, R, Rupprechter, H, Engelmann, C, Ozdogan, OC
Publicada:
1 may 2021
Ahead of Print:
1 abr 2021
Resumen:
Background & Aims: Acute decompensation (AD) of cirrhosis may present without acute-on-chronic liver failure (ACLF) (ADNo 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 90day 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. (c) 2020 European Association for the Study of the Liver. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Filiaciones:
Trebicka, J:
European Fdn Study Chron Liver Failure, EF Clif, Travesera Gracia 11,7th Floor, Barcelona 08021, Spain
Goethe Univ Frankfurt, Dept Internal Med 1, Frankfurt, Germany
Munster Univ Hosp, Munster, Germany
Univ Basel, St Gall Cantonal Hosp, Basel, Switzerland
Fernandez, J:
European Fdn Study Chron Liver Failure, EF Clif, Travesera Gracia 11,7th Floor, Barcelona 08021, Spain
Univ Barcelona, Hosp Clin Barcelona, IDIBAPS, CIBEReHD, Barcelona, Spain
Munster Univ Hosp, Munster, Germany
Univ Birmingham, Birmingham, W Midlands, England
Papp, M:
Univ Debrecen, Fac Med, Inst Med, Dept Gastroenterol, Debrecen, Hungary
Caraceni, P:
Univ Bologna, Bologna, Italy
Laleman, W:
Univ Leuven, Dept Gastroenterol & Hepatol, Sect Liver & Biliopancreat Disorders, Leuven, Belgium
Gambino, C:
Univ Padua, Padua, Italy
Giovo, I:
AOU Citta Salute & Sci Torino, Turin, Italy
Uschner, FE:
Goethe Univ Frankfurt, Dept Internal Med 1, Frankfurt, Germany
Univ Basel, St Gall Cantonal Hosp, Basel, Switzerland
Jansen, C:
Univ Hosp Bonn, Dept Internal Med 1, Bonn, Germany
Hop Univ Geneve, Geneva, Switzerland
Jimenez, C:
Univ Autonoma Barcelona, Hosp Vall dHebron, Liver Unit, CIBEREHD, Barcelona, Spain
Mookerjee, R:
Royal Free Hosp, UCL Med Sch, London, England
Gustot, T:
CUB Erasme, Brussels, Belgium
Albillos, A:
Univ Alcald, Hosp Univ Ramon y Cajal, Dept Gastroenterol, CIBEREHD, Madrid, Spain
Banares, R:
Univ Complutense Madrid, CIBERehd, Fac Med, Hosp Gen Univ Gregorio Maranon, Madrid, Spain
Jarcuska, P:
Pavol Jozef Safarik Univ Kosice, Kosice, Slovakia
Steib, C:
LMU, Liver Ctr Munich, Dept Med 2, Univ Hosp, Munich, Germany
Reiberger, T:
Med Univ Vienna, Vienna, Austria
Acevedo, J:
Univ Hosp Plymouth NHS Trust, Plymouth, Devon, England
Gatti, P:
ASL Brindisi, Intenal Med PO Ostuni, Brindisi, Italy
Shawcross, DL:
Kings Coll Hosp London, London, England
Zeuzem, S:
Goethe Univ Frankfurt, Dept Internal Med 1, Frankfurt, Germany
Univ Basel, St Gall Cantonal Hosp, Basel, Switzerland
Zipprich, A:
Univ Hosp Halle Wittenberg, Halle, Germany
Piano, S:
Univ Padua, Padua, Italy
Berg, T:
Leipzig Univ Med Ctr, Dept Med 2, Div Hepatol, Leipzig, Germany
Bruns, T:
Jena Univ Hosp, Jena, Germany
Univ Copenhagen, Hvidovre Hosp, Gastro Unit, Med Sect, Copenhagen, Denmark
Univ Copenhagen, Dept Clin Med, Gastro Unit, Med Sect, Copenhagen, Denmark
Danielsen, KV:
Med Univ Innsbruck, Innsbruck, Austria
Coenraad, M:
Leiden Univ, Med Ctr, Leiden, Netherlands
Merli, M:
Univ Sapienza Roma, Rome, Italy
Stauber, R:
Med Univ Graz, Graz, Austria
Zoller, H:
Med Univ Innsbruck, Innsbruck, Austria
Ramos, JP:
CHTMAD Vila Real, Blueclin, Vila Real, Portugal
Sole, C:
Univ Barcelona, Hosp Clin Barcelona, IDIBAPS, CIBEReHD, Barcelona, Spain
Univ Birmingham, Birmingham, W Midlands, England
Soriano, G:
Univ Clin Visceral Surg & Med Inselspital, Univ Svizzera Italiana, Bern & Ente Osped Cantonale, Lugano, Switzerland
De Gottardi, A:
Hosp La Santa Creu & St Pau, CIBERehd, Barcelona, Spain
Gronbaek, H:
Aarhus Univ Hosp, Aarhus, Denmark
Saliba, F:
Univ Paris Saclay, Hop Paul Brousse, AP HP, Ctr Hepatobiliaire,INSERM Unit 1193, Villejuif, France
Trautwein, C:
Aachen Univ Hosp, Aachen, Germany
Kani, HT:
Marmara Univ, Kadikoy, Turkey
Francque, S:
Univ Hosp Antwerp, Antwerp, Belgium
Ryder, S:
Nottingham Univ Hosp NHS Trust, NIHR Biomed Res Ctr, Nottingham, England
Univ Nottingham, Nottingham, England
Nahon, P:
Hop Jean Verdier, AP HP, Serv Hepatol, Bondy, France
Univ Paris 13, Equipe Labellisee Ligue Canc, Sorbonne Paris Cite, St Denis, France
INSERM, Genom Fonct Tumeurs Solides, UMR 1162, Paris, France
Romero-Gomez, M:
Virgen Rocio Univ Hosp, Seville, Spain
Van Vlierberghe, H:
Ghent Univ Hosp, Ghent, Belgium
Francoz, C:
Hop Beaujon, AP HP, Serv Hepatol, Clichy, France
Univ Paris, Ctr Rech Inflammat, INSERM, Paris, France
Manns, M:
Hannover Med Sch, Hannover, Germany
Garcia-Lopez, E:
European Fdn Study Chron Liver Failure, EF Clif, Travesera Gracia 11,7th Floor, Barcelona 08021, Spain
Munster Univ Hosp, Munster, Germany
Tufoni, M:
Univ Bologna, Bologna, Italy
Amoros, A:
European Fdn Study Chron Liver Failure, EF Clif, Travesera Gracia 11,7th Floor, Barcelona 08021, Spain
Munster Univ Hosp, Munster, Germany
Pavesi, M:
European Fdn Study Chron Liver Failure, EF Clif, Travesera Gracia 11,7th Floor, Barcelona 08021, Spain
Munster Univ Hosp, Munster, Germany
Sanchez, C:
European Fdn Study Chron Liver Failure, EF Clif, Travesera Gracia 11,7th Floor, Barcelona 08021, Spain
Munster Univ Hosp, Munster, Germany
Praktiknjo, M:
Univ Hosp Bonn, Dept Internal Med 1, Bonn, Germany
Hop Univ Geneve, Geneva, Switzerland
Curto, A:
European Fdn Study Chron Liver Failure, EF Clif, Travesera Gracia 11,7th Floor, Barcelona 08021, Spain
Munster Univ Hosp, Munster, Germany
Pitarch, C:
European Fdn Study Chron Liver Failure, EF Clif, Travesera Gracia 11,7th Floor, Barcelona 08021, Spain
Munster Univ Hosp, Munster, Germany
Putignano, A:
CUB Erasme, Brussels, Belgium
Moreno, E:
European Fdn Study Chron Liver Failure, EF Clif, Travesera Gracia 11,7th Floor, Barcelona 08021, Spain
Munster Univ Hosp, Munster, Germany
Bernal, W:
Kings Coll Hosp London, London, England
Aguilar, F:
European Fdn Study Chron Liver Failure, EF Clif, Travesera Gracia 11,7th Floor, Barcelona 08021, Spain
Munster Univ Hosp, Munster, Germany
Claria, J:
European Fdn Study Chron Liver Failure, EF Clif, Travesera Gracia 11,7th Floor, Barcelona 08021, Spain
Univ Barcelona, Hosp Clin Barcelona, IDIBAPS, CIBEReHD, Barcelona, Spain
Munster Univ Hosp, Munster, Germany
Univ Birmingham, Birmingham, W Midlands, England
Ponzo, P:
AOU Citta Salute & Sci Torino, Turin, Italy
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
Gerbes, A:
LMU, Liver Ctr Munich, Dept Med 2, Univ Hosp, Munich, Germany
Vargas, V:
Univ Autonoma Barcelona, Hosp Vall dHebron, Liver Unit, CIBEREHD, Barcelona, Spain
Alessandria, C:
AOU Citta Salute & Sci Torino, Turin, Italy
Bernardi, M:
Univ Bologna, Bologna, Italy
Gines, P:
Univ Barcelona, Hosp Clin Barcelona, IDIBAPS, CIBEReHD, Barcelona, Spain
Univ Birmingham, Birmingham, W Midlands, England
Moreau, R:
European Fdn Study Chron Liver Failure, EF Clif, Travesera Gracia 11,7th Floor, Barcelona 08021, Spain
Hop Beaujon, AP HP, Serv Hepatol, Clichy, France
Univ Paris, Ctr Rech Inflammat, INSERM, Paris, France
Munster Univ Hosp, Munster, Germany
Angeli, P:
European Fdn Study Chron Liver Failure, EF Clif, Travesera Gracia 11,7th Floor, Barcelona 08021, Spain
Univ Padua, Padua, Italy
Munster Univ Hosp, Munster, Germany
Jalan, R:
European Fdn Study Chron Liver Failure, EF Clif, Travesera Gracia 11,7th Floor, Barcelona 08021, Spain
Royal Free Hosp, UCL Med Sch, London, England
Munster Univ Hosp, Munster, Germany
Arroyo, V:
European Fdn Study Chron Liver Failure, EF Clif, Travesera Gracia 11,7th Floor, Barcelona 08021, Spain
Munster Univ Hosp, Munster, Germany
Maschmeier, M:
European Fdn Study Chron Liver Failure, EF Clif, Travesera Gracia 11,7th Floor, Barcelona 08021, Spain
Munster Univ Hosp, Munster, Germany
Semela, D:
Goethe Univ Frankfurt, Dept Internal Med 1, Frankfurt, Germany
Univ Basel, St Gall Cantonal Hosp, Basel, Switzerland
Elkrief, L:
Univ Hosp Bonn, Dept Internal Med 1, Bonn, Germany
Hop Univ Geneve, Geneva, Switzerland
Elsharkawy, A:
Univ Barcelona, Hosp Clin Barcelona, IDIBAPS, CIBEReHD, Barcelona, Spain
Univ Birmingham, Birmingham, W Midlands, England
Tornai, T:
Univ Debrecen, Fac Med, Inst Med, Dept Gastroenterol, Debrecen, Hungary
Tornai, I:
Univ Debrecen, Fac Med, Inst Med, Dept Gastroenterol, Debrecen, Hungary
Altorjay, I:
Univ Debrecen, Fac Med, Inst Med, Dept Gastroenterol, Debrecen, Hungary
Antognoli, A:
Univ Bologna, Bologna, Italy
Baldassarre, M:
Univ Bologna, Bologna, Italy
Gagliardi, M:
Univ Bologna, Bologna, Italy
Bertoli, E:
Univ Padua, Padua, Italy
Mareso, S:
Univ Padua, Padua, Italy
Brocca, A:
Univ Padua, Padua, Italy
Campion, D:
AOU Citta Salute & Sci Torino, Turin, Italy
Saracco, GM:
AOU Citta Salute & Sci Torino, Turin, Italy
Rizzo, M:
AOU Citta Salute & Sci Torino, Turin, Italy
Lehmann, J:
Univ Autonoma Barcelona, Hosp Vall dHebron, Liver Unit, CIBEREHD, Barcelona, Spain
Pohlmann, A:
Univ Autonoma Barcelona, Hosp Vall dHebron, Liver Unit, CIBEREHD, Barcelona, Spain
Brol, MJ:
Univ Autonoma Barcelona, Hosp Vall dHebron, Liver Unit, CIBEREHD, Barcelona, Spain
Chang, J:
Univ Autonoma Barcelona, Hosp Vall dHebron, Liver Unit, CIBEREHD, Barcelona, Spain
Schierwagen, R:
Univ Hosp Plymouth NHS Trust, Plymouth, Devon, England
Sola, E:
Royal Free Hosp, UCL Med Sch, London, England
Amari, N:
CUB Erasme, Brussels, Belgium
Rodriguez, M:
Univ Alcald, Hosp Univ Ramon y Cajal, Dept Gastroenterol, CIBEREHD, Madrid, Spain
Nevens, F:
Univ Leuven, Dept Gastroenterol & Hepatol, Sect Liver & Biliopancreat Disorders, Leuven, Belgium
Clemente, A:
Univ Complutense Madrid, CIBERehd, Fac Med, Hosp Gen Univ Gregorio Maranon, Madrid, Spain
Janicko, M:
Pavol Jozef Safarik Univ Kosice, Kosice, Slovakia
Markwardt, D:
LMU, Liver Ctr Munich, Dept Med 2, Univ Hosp, Munich, Germany
Mandorfer, M:
Med Univ Vienna, Vienna, Austria
Welsch, C:
Univ Hosp Plymouth NHS Trust, Plymouth, Devon, England
Welzel, TM:
Univ Hosp Plymouth NHS Trust, Plymouth, Devon, England
Ciraci, E:
ASL Brindisi, Intenal Med PO Ostuni, Brindisi, Italy
Patel, V:
Kings Coll Hosp London, London, England
Ripoll, C:
Univ Hosp Halle Wittenberg, Halle, Germany
Herber, A:
Leipzig Univ Med Ctr, Dept Med 2, Div Hepatol, Leipzig, Germany
Horn, P:
Jena Univ Hosp, Jena, Germany
Bendtsen, F:
Univ Copenhagen, Hvidovre Hosp, Gastro Unit, Med Sect, Copenhagen, Denmark
Univ Copenhagen, Dept Clin Med, Gastro Unit, Med Sect, Copenhagen, Denmark
Gluud, LL:
Univ Copenhagen, Hvidovre Hosp, Gastro Unit, Med Sect, Copenhagen, Denmark
Univ Copenhagen, Dept Clin Med, Gastro Unit, Med Sect, Copenhagen, Denmark
Schaapman, J:
Leiden Univ, Med Ctr, Leiden, Netherlands
Riggio, O:
Univ Sapienza Roma, Rome, Italy
Rainer, F:
Med Univ Graz, Graz, Austria
Moritz, JT:
Med Univ Innsbruck, Innsbruck, Austria
Mesquita, M:
CHTMAD Vila Real, Blueclin, Vila Real, Portugal
Alvarado-Tapias, E:
Univ Clin Visceral Surg & Med Inselspital, Univ Svizzera Italiana, Bern & Ente Osped Cantonale, Lugano, Switzerland
Akpata, O:
Hosp La Santa Creu & St Pau, CIBERehd, Barcelona, Spain
Aamann, L:
Aarhus Univ Hosp, Aarhus, Denmark
Samuel, D:
Univ Paris Saclay, Hop Paul Brousse, AP HP, Ctr Hepatobiliaire,INSERM Unit 1193, Villejuif, France
Tresson, S:
Univ Paris Saclay, Hop Paul Brousse, AP HP, Ctr Hepatobiliaire,INSERM Unit 1193, Villejuif, France
Strnad, P:
Aachen Univ Hosp, Aachen, Germany
Amathieu, R:
Marmara Univ, Kadikoy, Turkey
Simon-Talero, M:
Univ Hosp Antwerp, Antwerp, Belgium
Smits, F:
CUB Erasme, Brussels, Belgium
Van den Ende, N:
Univ Leuven, Dept Gastroenterol & Hepatol, Sect Liver & Biliopancreat Disorders, Leuven, Belgium
Martinez, J:
Univ Alcald, Hosp Univ Ramon y Cajal, Dept Gastroenterol, CIBEREHD, Madrid, Spain
Garcia, R:
Univ Complutense Madrid, CIBERehd, Fac Med, Hosp Gen Univ Gregorio Maranon, Madrid, Spain
Rupprechter, H:
Med Univ Vienna, Vienna, Austria
Engelmann, C:
Leipzig Univ Med Ctr, Dept Med 2, Div Hepatol, Leipzig, Germany
Ozdogan, OC:
Nottingham Univ Hosp NHS Trust, NIHR Biomed Res Ctr, Nottingham, England
Univ Nottingham, Nottingham, England
Green Published, hybrid
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