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Luis Viola - One of the best experts on this subject based on the ideXlab platform.

Richard Moreau - One of the best experts on this subject based on the ideXlab platform.

  • Acute-on-Chronic Liver Failure.
    The New England journal of medicine, 2020
    Co-Authors: Vicente Arroyo, Richard Moreau, Rajiv Jalan
    Abstract:

    Acute-on-Chronic Liver Failure Acute decompensation in patients with Chronic Liver disease is called acute-on-Chronic Liver Failure. Usually, systemic inflammation from infection or an acute hepati...

  • development of predisposition injury response organ Failure model for predicting acute kidney injury in acute on Chronic Liver Failure
    Liver International, 2017
    Co-Authors: Rakhi Maiwall, Richard Moreau, Shiv Kumar Sarin, Suman Kumar, Priyanka Jain, Guresh Kumar, Ajeet Singh Bhadoria, Chandan Kumar Kedarisetty, Zaigham Abbas
    Abstract:

    Background and Aim There is limited data on predictors of acute kidney injury in acute on Chronic Liver Failure. We developed a PIRO model (Predisposition, Injury, Response, Organ Failure) for predicting acute kidney injury in a multicentric cohort of acute on Chronic Liver Failure patients. Patients and Methods Data of 2360 patients from APASL-ACLF Research Consortium (AARC) was analysed. Multivariate logistic regression model (PIRO score) was developed from a derivation cohort (n=1363) which was validated in another prospective multicentric cohort of acute on Chronic Liver Failure patients (n=997). Results Factors significant for P component were serum creatinine[(≥2 mg/dL)OR 4.52, 95% CI (3.67-5.30)], bilirubin [(<12 mg/dL,OR 1) vs (12-30 mg/dL,OR 1.45, 95% 1.1-2.63) vs (≥30 mg/dL,OR 2.6, 95% CI 1.3-5.2)], serum potassium [(<3 mmol/LOR-1) vs (3-4.9 mmol/L,OR 2.7, 95% CI 1.05-1.97) vs (≥5 mmol/L,OR 4.34, 95% CI 1.67-11.3)] and blood urea (OR 3.73, 95% CI 2.5-5.5); for I component nephrotoxic medications (OR-9.86, 95% CI 3.2-30.8); for R component,Systemic Inflammatory Response Syndrome,(OR-2.14, 95% CI 1.4-3.3); for O component, Circulatory Failure (OR-3.5, 95% CI 2.2-5.5). The PIRO score predicted acute kidney injury with C-index of 0.95 and 0.96 in the derivation and validation cohort. The increasing PIRO score was also associated with mortality (P<.001) in both the derivation and validation cohorts. Conclusions The PIRO model identifies and stratifies acute on Chronic Liver Failure patients at risk of developing acute kidney injury. It reliably predicts mortality in these patients, underscoring the prognostic significance of acute kidney injury in patients with acute on Chronic Liver Failure.

  • Acute-on-Chronic Liver Failure in cirrhosis.
    Nature reviews. Disease primers, 2016
    Co-Authors: Vicente Arroyo, Richard Moreau, Rajiv Jalan, Pere Gines, Patrick S Kamath, Guadalupe Garcia-tsao, Frederik Nevens, Javier Fernández, Bernd Schnabl
    Abstract:

    The definition of acute-on-Chronic Liver Failure (ACLF) remains contested. In Europe and North America, the term is generally applied according to the European Association for the Study of the Liver-Chronic Liver Failure (EASL-CLIF) Consortium guidelines, which defines this condition as a syndrome that develops in patients with cirrhosis and is characterized by acute decompensation, organ Failure and high short-term mortality. One-third of patients who are hospitalized for acute decompensation present with ACLF at admission or develop the syndrome during hospitalization. ACLF frequently occurs in a closed temporal relationship to a precipitating event, such as bacterial infection or acute alcoholic, drug-induced or viral hepatitis. However, no precipitating event can be identified in approximately 40% of patients. The mechanisms of ACLF involve systemic inflammation due to infections, acute Liver damage and, in cases without precipitating events, probably intestinal translocation of bacteria or bacterial products. ACLF is graded into three stages (ACLF grades 1-3) on the basis of the number of organ Failures, with higher grades associated with increased mortality. Liver and renal Failures are the most common organ Failures, followed by coagulation, brain, circulatory and respiratory Failure. The 28-day mortality rate associated with ACLF is 30%. Depending on the grade, ACLF can be reversed using standard therapy in only 16-51% of patients, leaving a considerable proportion of patients with ACLF that remains steady or progresses. Liver transplantation in selected patients with ACLF grade 2 and ACLF grade 3 increases the 6-month survival from 10% to 80%.

  • Acute-on-Chronic Liver Failure: Recent Concepts
    Journal of clinical and experimental hepatology, 2014
    Co-Authors: Richard Moreau, Rajiv Jalan, Vicente Arroyo
    Abstract:

    A proportion of patients hospitalized for an acute complication of cirrhosis are at high risk of short-term death. The term Acute-on-Chronic Liver Failure (ACLF) is used to characterize these patients. Until recently there was no evidence-based definition of ACLF. In 2013 a definition has been proposed based on results of a large prospective observational European study, called “European Association for the Study of the Liver (EASL)–Chronic Liver Failure (CLIF) Consortium Acute-on-Chronic Liver Failure in Cirrhosis (CANONIC)” study. Results of this study led to elaborate new concepts about ACLF. First, it was found that ACLF is a syndrome that is distinct from mere decompensated cirrhosis. It was also shown that ACLF is a dynamic syndrome which can improve or conversely worsen. Patients who worsen die rapidly from multiorgan Failures. The CANONIC study also found that identifiable precipitating events (e.g., bacterial infection, active alcoholism) are found in only 50% of cases of ACLF indicating that these events are dispensable for defining ACLF. In addition precipitating events may be initiators of ACLF but do not drive the outcome. An important concept derived from the CANONIC study is that ACLF is associated with systemic inflammation even in patients who do not have identifiable precipitating events. Finally it was found that ACLF may develop in patients without prior episodes of decompensation or in those with recent decompensation (

  • Acute-on-Chronic Liver Failure: a new clinical entity.
    Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2014
    Co-Authors: Richard Moreau, Vicente Arroyo
    Abstract:

    Patients hospitalized for an acute complication of cirrhosis who also have organ Failure(s) are at high risk of short-term death. The term acute-on-Chronic Liver Failure (ACLF) is used to characterize these patients. Until recently, there was no evidence-based definition of ACLF. The results of a large prospective observational European study called Chronic Liver Failure Consortium Acute-on-Chronic Liver Failure in Cirrhosis study were published in 2013 establishing diagnostic criteria for ACLF in a large series of hospitalized patients who had an acute complication of cirrhosis. In addition, this study described the natural history of ACLF. According to the Acute-on-Chronic Liver Failure in Cirrhosis study, ACLF is now considered a new clinical entity because it is distinct from traditional decompensated cirrhosis, based not only on the presence of organ Failure(s) and high mortality rate but also on younger age, alcoholic etiology of cirrhosis, higher prevalence of some precipitating events (bacterial infections, active alcoholism), and higher level of systemic inflammation. ACLF is a new entity also because it cannot be explained entirely by severe sepsis or severe alcoholic hepatitis; a large proportion of cases are of unknown origin. ACLF should be considered as a whole that includes subcategories such as severe sepsis, severe alcoholic hepatitis, and others, which have yet to be defined. ACLF is a relatively common syndrome because it occurs in 31% of hospitalized patients with cirrhosis who have an acute complication of their Liver disease. In these patients, ACLF is the most common cause of death.

Dong Joon Kim - One of the best experts on this subject based on the ideXlab platform.

  • Acute-on-Chronic Liver Failure as a major predictive factor for mortality in patients with variceal bleeding.
    Clinical and molecular hepatology, 2020
    Co-Authors: Jongbeom Shin, Seon Song, Young-joo Jin, Hyung Joon Yim, Young Kul Jung, Jin Mo Yang, Young Seok Kim, Sang Gyune Kim, Dong Joon Kim
    Abstract:

    BACKGROUND/AIMS This study examined the risk factors associated with mortality in cirrhotic patients hospitalized with variceal bleeding, and evaluated the effects of acute-on-Chronic Liver Failure (ACLF) on the prognosis of these patients. METHODS This study was retrospectively conducted on patients registered in the Korean acute-on-Chronic Liver Failure study cohort, and on 474 consecutive cirrhotic patients hospitalized with variceal bleeding from January 2013 to December 2013 at 21 university hospitals. ACLF was defined as described by the European Association for the Study of Liver-Chronic Liver Failure Consortium. RESULTS Among a total of 474 patients, 61 patients were diagnosed with ACLF. The cumulative overall survival (OS) rate was lower in the patients with ACLF than in those without (P

  • Schiff's Diseases of the Liver - Acute-on-Chronic Liver Failure
    The Korean Journal of Medicine, 2017
    Co-Authors: Dong Joon Kim
    Abstract:

    Acute-on-Chronic Liver Failure (ACLF) is increasingly recognized as a distinct disease entity associated with acute deterioration of Liver function in patients with Chronic Liver disease. Although no widely accepted diagnostic criteria for ACLF are yet available, the definitions of the Asian-Pacific Association for the Study of the Liver (APASL) ACLF Research Consortium (AARC) and the European Association for the Study of the Liver (EASL) Chronic Liver Failure Consortium (CLIF-C) are commonly employed. However, the AARC and CLIF-C criteria are based on fundamentally different features, rendering among-study comparisons difficult. The areas of uncertainty include the definition and extent of heterogeneity of ACLF, ambiguities in terms of the underlying Liver disease, and whether infection or sepsis may precipitate the condition. Although the detailed pathogenesis of ACLF remains to be elucidated, changes in host responses to injury, infection, and uncontrolled inflammation play important roles. The “predisposition, infection/inflammation, response, organ Failure” (PIRO) concept used to evaluate sepsis may be valuable when it is sought to describe the pathophysiology and clinical features of ACLF. Currently, treatment is limited to organ support but a better understanding of the pathophysiology is likely to lead, in future, to the discovery of novel biomarkers and the development of new therapeutic strategies. (Korean J Med 2017;92:118-123)

  • Acute-on-Chronic Liver Failure.
    Clinical and molecular hepatology, 2013
    Co-Authors: Tae Yeob Kim, Dong Joon Kim
    Abstract:

    Acute-on-Chronic Liver Failure (ACLF) is an increasingly recognized distinct disease entity encompassing an acute deterioration of Liver function in patients with Chronic Liver disease. Although there are no widely accepted diagnostic criteria for ACLF, the Asia.Pacific Association for the Study of the Liver (APASL) and the American Association for the Study of Liver Disease and the European Association for the Study of the Liver (AASLD/EASL) consensus definitions are commonly used. It is obvious that the APASL and the AASLD/EASL definitions are based on fundamentally different features. Two different definitions in two different parts of the world hamper the comparability of studies. Recently, the EASL-Chronic Liver Failure Consortium proposed new diagnostic criteria for ACLF based on analyses of patients with organ Failure. There are areas of uncertainty in defining ACLF, such as heterogeneity of ACLF, ambiguity in qualifying underlying Liver disease, argument for infection or sepsis as a precipitating event, etc. Although the exact pathogenesis of ACLF remains to be elucidated, alteration of host response to injury, infection, and unregulated inflammation play important roles. The predisposition, infection/inflammation, response, organ Failure (PIRO) concept used for sepsis might be useful in describing the pathophysiology and clinical categories for ACLF. Treatment strategies are limited to organ support but better understanding of the pathophysiology is likely to lead to discovery of novel biomarkers and therapeutic strategies in the future.

Seon Song - One of the best experts on this subject based on the ideXlab platform.

  • Acute-on-Chronic Liver Failure as a major predictive factor for mortality in patients with variceal bleeding.
    Clinical and molecular hepatology, 2020
    Co-Authors: Jongbeom Shin, Seon Song, Young-joo Jin, Hyung Joon Yim, Young Kul Jung, Jin Mo Yang, Young Seok Kim, Sang Gyune Kim, Dong Joon Kim
    Abstract:

    BACKGROUND/AIMS This study examined the risk factors associated with mortality in cirrhotic patients hospitalized with variceal bleeding, and evaluated the effects of acute-on-Chronic Liver Failure (ACLF) on the prognosis of these patients. METHODS This study was retrospectively conducted on patients registered in the Korean acute-on-Chronic Liver Failure study cohort, and on 474 consecutive cirrhotic patients hospitalized with variceal bleeding from January 2013 to December 2013 at 21 university hospitals. ACLF was defined as described by the European Association for the Study of Liver-Chronic Liver Failure Consortium. RESULTS Among a total of 474 patients, 61 patients were diagnosed with ACLF. The cumulative overall survival (OS) rate was lower in the patients with ACLF than in those without (P

  • Long-term Prognosis of Acute-on-Chronic Liver Failure Survivors.
    Journal of clinical gastroenterology, 2019
    Co-Authors: Eileen L. Yoon, Tae Yeob Kim, Chang Hyeong Lee, Tae-hun Kim, Hyun Chin Cho, Sang Soo Lee, Sung Eun Kim, Hee Yeon Kim, Chang Wook Kim, Seon Song
    Abstract:

    Goals:We aimed to investigate significant factors influencing the long-term prognosis of patients who survived acute-on-Chronic Liver Failure (ACLF).Background:The mortality of ACLF is predominantly affected by the organ Failure severity. However, long-term outcomes of patients who survive ACLF are

  • Assessment of scoring systems for acute-on-Chronic Liver Failure at predicting short-Term mortality in patients with
    World journal of gastroenterology, 2016
    Co-Authors: Hee Yeon Kim, Tae Yeob Kim, Eileen L. Yoon, Sang Soo Lee, Chang Wook Kim, Seon Song, Young Kul Jung, Dong Hyun Sinn, Ki Tae Suk, Chang Hyeong Lee
    Abstract:

    Assessment of scoring systems for acute-on-Chronic Liver Failure at predicting short-term mortality in patients with alcoholic hepatitis

Cristian Dominguez - One of the best experts on this subject based on the ideXlab platform.