Hemostatic parameters predict 90-day mortality in hospitalized cirrhotic patients with acute decompensation

AbstractLiver cirrhosis is often complicated by an immunological imbalance known as cirrhosis-associated immune dysfunction. This study aimed to investigate disturbances in circulating monocytes and dendritic cells in patients with acute decompensation (AD) of cirrhosis. The sample included 39 adult cirrhotic patients hospitalized for AD, 29 patients with stable cirrhosis (SC), and 30 healthy controls (CTR). Flow cytometry was used to analyze monocyte and dendritic cell subsets in whole blood and quantify cytokines in plasma samples. Cirrhotic groups showed higher frequencies of intermediate monocytes (iMo) than CTR. AD patients had lower percentages of nonclassical monocytes than CTR and SC. Cirrhotic patients had a profound reduction in absolute and relative dendritic cell numbers compared with CTR and showed higher plasmacytoid/classical dendritic cell ratios. Increased plasma levels of IL-6, IL-10, and IL-17A, elevated percentages of CD62L+ monocytes, and reduced HLA-DR expression on classical monocytes (cMo) were also observed in cirrhotic patients. Patients with more advanced liver disease showed increased cMo and reduced tissue macrophages (TiMas) frequencies. It was found that cMo percentages greater than 90.0% within the monocyte compartment and iMo and TiMas percentages lower than 5.7% and 8.6%, respectively, were associated with increased 90-day mortality. Monocytes and dendritic cells are deeply altered in cirrhotic patients, and subset profiles differ between stable and advanced liver disease. High cMo and low TiMas frequencies may be useful biomarkers of disease severity and mortality in liver cirrhosis.

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Acute Decompensation and Absence of Brain and Kidney Dysfunction Predict Long-Term Efficacy of Plasma Exchange in Hyper-Bilirubinemic Cirrhotic Patients Awaiting Liver Transplantation

Transplantation Proceedings ◽

10.1016/j.transproceed.2008.05.064 ◽

2008 ◽

Vol 40 (6) ◽

pp. 1929-1931

Author(s):

B.E. Annicchiarico ◽

A.W. Avolio ◽

M. Siciliano ◽

S. Passalacqua ◽

G. Caracciolo ◽

...

Keyword(s):

Liver Transplantation ◽

Plasma Exchange ◽

Kidney Dysfunction ◽

Term Efficacy ◽

Acute Decompensation ◽

Cirrhotic Patients

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Red blood cell distribution width independently predicts 1-month mortality in acute decompensation of cirrhotic patients admitted to emergency department

European Journal of Gastroenterology & Hepatology ◽

10.1097/meg.0000000000000993 ◽

2018 ◽

Vol 30 (1) ◽

pp. 33-38 ◽

Cited By ~ 5

Author(s):

Gianni Turcato ◽

Tommaso Campagnaro ◽

Antonio Bonora ◽

Nicola Vignola ◽

Gian Luca Salvagno ◽

...

Keyword(s):

Emergency Department ◽

Blood Cell ◽

Red Blood Cell ◽

Cell Distribution ◽

Distribution Width ◽

Acute Decompensation ◽

Cirrhotic Patients ◽

Red Blood Cell Distribution

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Applicability of the Chronic Liver Failure-Consortium score in patients with cirrhosis and bacterial infections: a single-clinic experience

GASTROENTEROLOGY ◽

10.22141/2308-2097.55.4.2021.247915 ◽

2021 ◽

Vol 55 (4) ◽

pp. 239-245

Author(s):

D.I. Haurylenka ◽

N.N. Silivontchik

Keyword(s):

Liver Failure ◽

Bacterial Infections ◽

Serum Bilirubin Level ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Acute Decompensation ◽

Clinic Experience ◽

Cirrhotic Patients ◽

The City ◽

Number Needed To Harm

Background. The frequency and characteristics of acute-on-chronic liver failure (ACLF) are reported in numerous articles from different countries. The aim of the study was to assess the cirrhosis decompensation in patients with bacterial infections based on the Chronic Liver Failure-Consortium (CLIF-C) score in one of the city clinics in Belarus. Materials and methods. The patients underwent laboratory and instrumental studies during the hospitalization. The assessment of the syndrome of acute-on-chronic liver failure was performed using the CLIF-C score. Bacterial infections were diagnosed on the basis of standard criteria. Results. The study included 151 cirrhotic patients, 87 males and 64 females. Median age was 55 years (Q1 = 43; Q3 = 61). Cirrhosis was predominantly due to alcohol addiction — 83 patients (55 %). ACLF was diagnosed in 44 of 151 patients with cirrhosis (29.1 %; 95% confidence interval (CI) 22.0–37.1). Bacterial infections were detected in 67 people (44.4 %; 95% CI 36.3–52.7). Most often patients had liver failure that was detected by an increase in serum bilirubin level. Among individuals with upper gastrointestinal bleedings, number needed to harm for developing ACLF was 3.3 (95% CI 2.2–4.4). The risk of developing ACLF grade 2 and 3 in cirrhotic patients with infections was 8.2, with 95% CI 1.0–69.6 (number needed to harm was 12.9; 95% CI 10.7–15.0). Bacterial infections increase the risk of acute decompensation in patients with cirrhosis (odds ratio = 2.0, p = 0.048). Conclusions. The CLIF-C score is quite applicable in our cohort of patients with cirrhosis.

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