Increased Endotoxin Activity Is Associated with the Risk of Developing Acute-on-Chronic Liver Failure

Acute-on-chronic liver failure (ACLF) leads to systematic inflammatory response syndrome and multiple organ failure. This study investigated the relationship between endotoxin (Et) and ACLF with the aim of determining whether Et activity (EA) is useful as a predictive biomarker of ACLF development and whether rifaximin treatment decreased the risk of ACLF development. Two hundred forty-nine patients with liver cirrhosis were enrolled in this study. Et concentration was determined in the whole blood by a semiquantitative EA assay. Predictive factors of ACLF development and the risk of ACLF development with and without rifaximin treatment were identified by univariate and multivariate analysis using Fine and Gray’s proportional subhazards model. EA level was higher in Child-Pugh class B than in class A patients, and class B patients had an increased risk of ACLF development compared with class A patients. Multivariate analysis showed that EA level was a predictive factor independently associated with ACLF development. Rifaximin decreased EA level and the risk of ACLF development in Child-Pugh class B patients. Et levels were associated with functional liver capacity and were predictive of ACLF development in cirrhotic patients. Rifaximin decreased Et level and the risk of ACLF development in advanced cirrhotic patients.

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Combination and sequential evaluation of acute-on-chronic liver failure (ACLF) and hyponatremia and prognosis in cirrhotic patients

Digestive and Liver Disease ◽

10.1016/j.dld.2019.08.013 ◽

2020 ◽

Vol 52 (1) ◽

pp. 91-97 ◽

Cited By ~ 1

Author(s):

Gustavo Pereira ◽

Caroline Baldin ◽

Juliana Piedade ◽

Vanessa Reis ◽

Tatiana Valdeolivas ◽

...

Keyword(s):

Liver Failure ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Cirrhotic Patients ◽

Sequential Evaluation

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Main clinical characteristics of hospitalized cirrhotic patients with acute on chronic liver failure

Annals of Hepatology ◽

10.1016/j.aohep.2020.08.005 ◽

2020 ◽

Vol 19 ◽

pp. 2

Author(s):

C.I. Díaz-Valencia ◽

F.A. Lajud-Barquin ◽

M.F. Higuera de la Tijera ◽

J.L. Pérez-Hernández

Keyword(s):

Liver Failure ◽

Clinical Characteristics ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Cirrhotic Patients

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Liver transplantation in the most severely ill cirrhotic patients: A multicenter study in acute-on-chronic liver failure grade 3

Journal of Hepatology ◽

10.1016/j.jhep.2017.06.009 ◽

2017 ◽

Vol 67 (4) ◽

pp. 708-715 ◽

Cited By ~ 103

Author(s):

Florent Artru ◽

Alexandre Louvet ◽

Isaac Ruiz ◽

Eric Levesque ◽

Julien Labreuche ◽

...

Keyword(s):

Liver Transplantation ◽

Liver Failure ◽

Multicenter Study ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Cirrhotic Patients ◽

Grade 3

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566 PROTON NMR SERUM METABOLOMIC FINGERPRINT OF ACUTE ON CHRONIC LIVER FAILURE (AOCLF) IN ICU CIRRHOTIC PATIENTS

Journal of Hepatology ◽

10.1016/s0168-8278(12)60579-0 ◽

2012 ◽

Vol 56 ◽

pp. S225

Author(s):

R. Amathieu ◽

M.N. Triba ◽

P. Nahon ◽

N. Bouchemal ◽

W. Kamoun ◽

...

Keyword(s):

Liver Failure ◽

Proton Nmr ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Cirrhotic Patients

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Interlobar Artery Resistive Index predicts Acute-on-Chronic Liver Failure Syndrome in Cirrhotic Patients with Acute Decompensation

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/s-0042-120258 ◽

2017 ◽

Vol 39 (01) ◽

pp. 39-47 ◽

Cited By ~ 1

Author(s):

Pablo Solís-Muñoz ◽

Christopher Willars ◽

Julia Wendon ◽

George Auzinger ◽

Michael Heneghan ◽

...

Keyword(s):

Liver Failure ◽

Predictive Accuracy ◽

Univariate Analysis ◽

Resistive Index ◽

Chronic Liver ◽

Ultrasound Measurement ◽

Chronic Liver Failure ◽

Short Term ◽

Predictive Values ◽

Cirrhotic Patients

Abstract Introduction Patients with acutely decompensated (AD) cirrhosis are at risk for developing acute-on-chronic liver failure (ACLF) syndrome. This syndrome is associated with a high short-term mortality rate. The aim of our study was to identify reliable early predictors of developing ACLF in cirrhotic patients with AD. Patients and Methods We assessed 84 cirrhotic patients admitted for AD without ACLF on admission. We performed routine blood testing and detailed ultrasound Doppler studies of systemic arteries and mayor abdominal veins and arteries. We also calculated liver-specific and intensive care unit predictive scores. The area under the ROC curve (AUROC) was calculated for all variables that were significantly different between patients who developed ACLF and those who did not. Sensitivity, specificity, positive and negative predictive values, as well as diagnostic accuracy predicting the short-term development of ACLF were determined. Results of the 84 patients, 23 developed ACLF whereas 61 did not. In the univariate analysis, serum levels of creatinine and urea, prothrombin time ratio, MELD score, portal vein and femoral artery flow velocity as well as the renal and interlobar artery resistive indices (RI) were associated with the short-term development of ACLF. However, only interlobar artery RI had independent predictive value in the multivariate analysis. The AUROC value for RI of the interlobar arteries was 0.9971. Conclusion On the first day of admission, ultrasound measurement of the RI of the interlobar arteries recognizes with high predictive accuracy those cirrhotic patients admitted with AD who will develop ACLF during hospital admission.

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Correlation between Hepatic Vein Wave form Changes on Doppler Ultrasound and the Severity of Diseases in Cirrhotic Patients

Journal of Medicine ◽

10.3329/jom.v22i2.56698 ◽

2021 ◽

Vol 22 (2) ◽

pp. 100-106

Author(s):

Tarana Yasmin ◽

Sohely Sultana ◽

Mahmuda Nusrat Ima ◽

Md Quamrul Islam ◽

Shyamal Kumar Roy ◽

...

Keyword(s):

Liver Cirrhosis ◽

Doppler Ultrasound ◽

Hepatic Vein ◽

Wave Form ◽

Venous Blood Flow ◽

Class A ◽

Class B ◽

Pugh Class ◽

Cirrhotic Patients ◽

Class C

Background: Cirrhosis is a common problem and is a leading cause of chronic liver disease. Early diagnosis with assessment of severity of diseases may help prevent the associated complications and patients’ sufferings. Now a days Hepatic venous Doppler can be a tool for diagnosis of cirrhosis and to assess correlation between waveform changes and severity of diseases. Objective: The purposes of this study was to determine the significance of hepatic vein waveform changes on doppler ultrasound in cirrhotic patients and to correlate with liver dysfunction. Materials and methods: This study was carried out in the department of Radiology and Imaging of Enam Medical College and Hospital during January 2017 to May 2018. Doppler waveforms were obtained from right hepatic vein in all the cases and classified as triphasic, biphasic and monophasic. Waveform comparisons were made among patients with differing grades of cirrhosis. Child- Pugh class was used to assess severity of cirrhosis. Doppler sonography was done in 80 patients suspecting of having liver cirrhosis. Data on clinical findings, B mode sonographic findings and hepatic vein doppler ultrasound findings were collected and documented in structured forms. Analysis was done using SPSS - 20. Results: Total of 80 patients who met the inclusion criteria are included in the study with mean age of 45.37±7.64 (range 25-75) years. Among these 57 (71%) were males while 23(29%) were females. On the basis of hepatic function 25 (31%) patients presented in Child-Pugh Class A, 31(39%) with Class B and 24(30%) patients had Class C. Hepatic venous waveform was triphasic in 22 (27.5%), biphasic in 28(35%), and monophasic in 30 (37.5%) cases. Our study revealed 88% (21) of Child- Pugh Class C, 23% (7) of Class B and 8% (2) of class A patients had monophasic HV waveform. The hepatic venous waveform progressively changed from triphasic to biphasic to monophasic with advancing grade of cirrhosis. The relationship of these waveforms change had significant relation with hepatic dysfunction (p < 0.022). Conclusion: Hepatic vein wave form changes reflects the change in hepatic circulation associated with progression of liver cirrhosis. It can be used as a new parameter in the assessment of severity of liver cirrhosis. Thus, alteration in hepatic venous blood flow pattern on doppler ultrasound can be a useful noninvasive tool for evaluating diseases severity in patients with cirrhosis. J MEDICINE 2021; 22: 100-106

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TO ELUCIDATE PRECIPATING FACTORS, CLINICAL PROFILE AND OUTCOME OF ACUTE-ON-CHRONIC LIVER FAILURE IN CIRRHOTIC PATIENTS.

British Journal of Medical and Health Research ◽

10.46624/bjmhr.2020.v7.i12.004 ◽

2020 ◽

Vol 7 (12) ◽

pp. 44-61

Author(s):

Netaji Garad

Keyword(s):

Liver Failure ◽

Chronic Liver ◽

Clinical Profile ◽

Chronic Liver Failure ◽

Cirrhotic Patients

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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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