dc.creator | Trebicka, Joel | es |
dc.creator | Fernandez, Javier | es |
dc.creator | Papp, Maria | es |
dc.creator | Caraceni, Paolo | es |
dc.creator | Laleman, Win | es |
dc.creator | Gambini, Carmine | es |
dc.creator | Romero Gómez, Manuel | es |
dc.creator | Arroyo, Vicente | es |
dc.date.accessioned | 2022-11-09T16:19:41Z | |
dc.date.available | 2022-11-09T16:19:41Z | |
dc.date.issued | 2021 | |
dc.identifier.citation | Trebicka, J., Fernandez, J., Papp, M., Caraceni, P., Laleman, W., Gambini, C.,...,Arroyo, V. (2021). PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis. Journal of Hepatology, 74 (5), 1097-1108. https://doi.org/10.1016/j.jhep.2020.11.019. | |
dc.identifier.issn | 0168-8278 | es |
dc.identifier.issn | 1600-0641 (electrónico) | es |
dc.identifier.uri | https://hdl.handle.net/11441/139193 | |
dc.description.abstract | Background & Aims: Acute decompensation (AD) of cirrhosis
may present without acute-on-chronic liver failure (ACLF) (AD No 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, in tensity, and relationship to outcome.
Results: Among various clinical events, 4 distinct events were
precipitants consistently related to AD: proven bacterial in fections, 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%, respec tively) 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 90-
day mortality and was paralleled by increasing levels of surro gates 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 signifi cantly 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 char acterized by a rapid deterioration in patient health. Herein, we
aimed to analyze the precipitating events that cause AD in pa tients 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 fail ure. 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 pre ventive and therapeutic strategies targeting these events may
improve patient outcomes. | es |
dc.format | application/pdf | es |
dc.format.extent | 12 p. | es |
dc.language.iso | eng | es |
dc.publisher | ELSEVIER SCIENCE BV | es |
dc.relation.ispartof | Journal of Hepatology, 74 (5), 1097-1108. | |
dc.rights | Attribution-NonCommercial-NoDerivatives 4.0 Internacional | * |
dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/4.0/ | * |
dc.subject | Chronic liver disease | es |
dc.subject | Non-elective admission | es |
dc.subject | Acute complications | es |
dc.subject | Outcome | es |
dc.subject | Risk factors | es |
dc.title | PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis | es |
dc.type | info:eu-repo/semantics/article | es |
dcterms.identifier | https://ror.org/03yxnpp24 | |
dc.type.version | info:eu-repo/semantics/publishedVersion | es |
dc.rights.accessRights | info:eu-repo/semantics/openAccess | es |
dc.contributor.affiliation | Universidad de Sevilla. Departamento de Medicina | es |
dc.relation.publisherversion | https://www.sciencedirect.com/science/article/pii/S0168827820337727?via%3Dihub | es |
dc.identifier.doi | 10.1016/j.jhep.2020.11.019 | es |
dc.journaltitle | Journal of Hepatology | es |
dc.publication.volumen | 74 | es |
dc.publication.issue | 5 | es |
dc.publication.initialPage | 1097 | es |
dc.publication.endPage | 1108 | es |