Advanced search
1 file | 799.01 KB Add to list

PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis

(2021) JOURNAL OF HEPATOLOGY. 74(5). p.1097-1108
Author
Organization
Abstract
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/).
Keywords
Chronic liver disease, Non-elective admission, Acute complications, Risk, factors

Downloads

  • 1-s2.0-S0168827820337727-main.pdf
    • full text (Published version)
    • |
    • open access
    • |
    • PDF
    • |
    • 799.01 KB

Citation

Please use this url to cite or link to this publication:

MLA
Trebicka, Jonel, et al. “PREDICT Identifies Precipitating Events Associated with the Clinical Course of Acutely Decompensated Cirrhosis.” JOURNAL OF HEPATOLOGY, vol. 74, no. 5, 2021, pp. 1097–108, doi:10.1016/j.jhep.2020.11.019.
APA
Trebicka, J., Fernandez, J., Papp, M., Caraceni, P., Laleman, W., Gambino, C., … Ozdogan, O. C. (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
Chicago author-date
Trebicka, Jonel, Javier Fernandez, Maria Papp, Paolo Caraceni, Wim Laleman, Carmine Gambino, Ilaria Giovo, et al. 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.
Chicago author-date (all authors)
Trebicka, Jonel, Javier Fernandez, Maria Papp, Paolo Caraceni, Wim Laleman, Carmine Gambino, Ilaria Giovo, Frank Erhard Uschner, Christian Jansen, Cesar Jimenez, Rajeshwar Mookerjee, Thierry Gustot, Agustin Albillos, Rafael Banares, Peter Jarcuska, Christian Steib, Thomas Reiberger, Juan Acevedo, Pietro Gatti, Debbie L. Shawcross, Stefan Zeuzem, Alexander Zipprich, Salvatore Piano, Thomas Berg, Tony Bruns, Karen Vagner Danielsen, Minneke Coenraad, Manuela Merli, Rudolf Stauber, Heinz Zoller, Jose Presa Ramos, Cristina Sole, German Soriano, Andrea de Gottardi, Henning Gronbaek, Faouzi Saliba, Christian Trautwein, Haluk Tarik Kani, Sven Francque, Stephen Ryder, Pierre Nahon, Manuel Romero-Gomez, Hans Van Vlierberghe, Claire Francoz, Michael Manns, Elisabet Garcia-Lopez, Manuel Tufoni, Alex Amoros, Marco Pavesi, Cristina Sanchez, Michael Praktiknjo, Anna Curto, Carla Pitarch, Antonella Putignano, Esau Moreno, William Bernal, Ferran Aguilar, Joan Claria, Paola Ponzo, Zsuzsanna Vitalis, Giacomo Zaccherini, Boglarka Balogh, Alexander Gerbes, Victor Vargas, Carlo Alessandria, Mauro Bernardi, Pere Gines, Richard Moreau, Paolo Angeli, Rajiv Jalan, Vicente Arroyo, Miriam Maschmeier, David Semela, Laure Elkrief, Ahmed Elsharkawy, Tamas Tornai, Istvan Tornai, Istvan Altorjay, Agnese Antognoli, Maurizio Baldassarre, Martina Gagliardi, Eleonora Bertoli, Sara Mareso, Alessandra Brocca, Daniela Campion, Giorgio Maria Saracco, Martina Rizzo, Jennifer Lehmann, Alessandra Pohlmann, Maximilian J. Brol, Johannes Chang, Robert Schierwagen, Elsa Sola, Nesrine Amari, Miguel Rodriguez, Frederik Nevens, Ana Clemente, Martin Janicko, Daniel Markwardt, Mattias Mandorfer, Christoph Welsch, Tanja M. Welzel, Emanuela Ciraci, Vish Patel, Cristina Ripoll, Adam Herber, Paul Horn, Flemming Bendtsen, Lise Lotte Gluud, Jelte Schaapman, Oliviero Riggio, Florian Rainer, Joerg Tobiasch Moritz, Monica Mesquita, Edilmar Alvarado-Tapias, Osagie Akpata, Luise Aamann, Didier Samuel, Sylvie Tresson, Pavel Strnad, Roland Amathieu, Macarena Simon-Talero, Francois Smits, Natalie van den Ende, Javier Martinez, Rita Garcia, Harald Rupprechter, Cornelius Engelmann, and Osman Cavit Ozdogan. 2021. “PREDICT Identifies Precipitating Events Associated with the Clinical Course of Acutely Decompensated Cirrhosis.” JOURNAL OF HEPATOLOGY 74 (5): 1097–1108. doi:10.1016/j.jhep.2020.11.019.
Vancouver
1.
Trebicka J, Fernandez J, Papp M, Caraceni P, Laleman W, Gambino C, et al. PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis. JOURNAL OF HEPATOLOGY. 2021;74(5):1097–108.
IEEE
[1]
J. Trebicka et al., “PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis,” JOURNAL OF HEPATOLOGY, vol. 74, no. 5, pp. 1097–1108, 2021.
@article{8708239,
  abstract     = {{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/).}},
  author       = {{Trebicka, Jonel and Fernandez, Javier and Papp, Maria and Caraceni, Paolo and Laleman, Wim and Gambino, Carmine and Giovo, Ilaria and Uschner, Frank Erhard and Jansen, Christian and Jimenez, Cesar and Mookerjee, Rajeshwar and Gustot, Thierry and Albillos, Agustin and Banares, Rafael and Jarcuska, Peter and Steib, Christian and Reiberger, Thomas and Acevedo, Juan and Gatti, Pietro and Shawcross, Debbie L. and Zeuzem, Stefan and Zipprich, Alexander and Piano, Salvatore and Berg, Thomas and Bruns, Tony and Danielsen, Karen Vagner and Coenraad, Minneke and Merli, Manuela and Stauber, Rudolf and Zoller, Heinz and Ramos, Jose Presa and Sole, Cristina and Soriano, German and de Gottardi, Andrea and Gronbaek, Henning and Saliba, Faouzi and Trautwein, Christian and Kani, Haluk Tarik and Francque, Sven and Ryder, Stephen and Nahon, Pierre and Romero-Gomez, Manuel and Van Vlierberghe, Hans and Francoz, Claire and Manns, Michael and Garcia-Lopez, Elisabet and Tufoni, Manuel and Amoros, Alex and Pavesi, Marco and Sanchez, Cristina and Praktiknjo, Michael and Curto, Anna and Pitarch, Carla and Putignano, Antonella and Moreno, Esau and Bernal, William and Aguilar, Ferran and Claria, Joan and Ponzo, Paola and Vitalis, Zsuzsanna and Zaccherini, Giacomo and Balogh, Boglarka and Gerbes, Alexander and Vargas, Victor and Alessandria, Carlo and Bernardi, Mauro and Gines, Pere and Moreau, Richard and Angeli, Paolo and Jalan, Rajiv and Arroyo, Vicente and Maschmeier, Miriam and Semela, David and Elkrief, Laure and Elsharkawy, Ahmed and Tornai, Tamas and Tornai, Istvan and Altorjay, Istvan and Antognoli, Agnese and Baldassarre, Maurizio and Gagliardi, Martina and Bertoli, Eleonora and Mareso, Sara and Brocca, Alessandra and Campion, Daniela and Saracco, Giorgio Maria and Rizzo, Martina and Lehmann, Jennifer and Pohlmann, Alessandra and Brol, Maximilian J. and Chang, Johannes and Schierwagen, Robert and Sola, Elsa and Amari, Nesrine and Rodriguez, Miguel and Nevens, Frederik and Clemente, Ana and Janicko, Martin and Markwardt, Daniel and Mandorfer, Mattias and Welsch, Christoph and Welzel, Tanja M. and Ciraci, Emanuela and Patel, Vish and Ripoll, Cristina and Herber, Adam and Horn, Paul and Bendtsen, Flemming and Gluud, Lise Lotte and Schaapman, Jelte and Riggio, Oliviero and Rainer, Florian and Moritz, Joerg Tobiasch and Mesquita, Monica and Alvarado-Tapias, Edilmar and Akpata, Osagie and Aamann, Luise and Samuel, Didier and Tresson, Sylvie and Strnad, Pavel and Amathieu, Roland and Simon-Talero, Macarena and Smits, Francois and van den Ende, Natalie and Martinez, Javier and Garcia, Rita and Rupprechter, Harald and Engelmann, Cornelius and Ozdogan, Osman Cavit}},
  issn         = {{0168-8278}},
  journal      = {{JOURNAL OF HEPATOLOGY}},
  keywords     = {{Chronic liver disease,Non-elective admission,Acute complications,Risk,factors}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{1097--1108}},
  title        = {{PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis}},
  url          = {{http://dx.doi.org/10.1016/j.jhep.2020.11.019}},
  volume       = {{74}},
  year         = {{2021}},
}

Altmetric
View in Altmetric
Web of Science
Times cited: