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Acute-on-Chronic Liver Failure: Recent Concepts.
J Clin Exp Hepatol. 2015 Mar; 5(1):81-5.JC

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 (<3 months). Moreover these patients with "early" ACLF were more severe than patients who developed ACLF after a long of history of decompensated cirrhosis.

Authors+Show Affiliations

Inserm, U1149, Centre de Recherche sur l'Inflammation (CRI), Clichy and Paris, France ; UMRS1149, Université Paris Diderot-Paris 7, Paris, France ; Département Hospitalo-Universitaire (DHU) UNITY, Service d'Hépatologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France ; Laboratoire d'Excellence Inflamex, PRES Sorbonne Paris Cité, Paris, France ; EASL-CLIF Consortium, Hospital Clinic, Centro de Investigacion Biomedica en Red Enfermedades Hepaticas y Digestivas (CIBERehd), Barcelona, Spain.EASL-CLIF Consortium, Hospital Clinic, Centro de Investigacion Biomedica en Red Enfermedades Hepaticas y Digestivas (CIBERehd), Barcelona, Spain ; Institute for Liver and Digestive Health, Royal Free Hospital, London, United Kingdom.EASL-CLIF Consortium, Hospital Clinic, Centro de Investigacion Biomedica en Red Enfermedades Hepaticas y Digestivas (CIBERehd), Barcelona, Spain ; Liver Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

25941435

Citation

Moreau, Richard, et al. "Acute-on-Chronic Liver Failure: Recent Concepts." Journal of Clinical and Experimental Hepatology, vol. 5, no. 1, 2015, pp. 81-5.
Moreau R, Jalan R, Arroyo V. Acute-on-Chronic Liver Failure: Recent Concepts. J Clin Exp Hepatol. 2015;5(1):81-5.
Moreau, R., Jalan, R., & Arroyo, V. (2015). Acute-on-Chronic Liver Failure: Recent Concepts. Journal of Clinical and Experimental Hepatology, 5(1), 81-5. https://doi.org/10.1016/j.jceh.2014.09.003
Moreau R, Jalan R, Arroyo V. Acute-on-Chronic Liver Failure: Recent Concepts. J Clin Exp Hepatol. 2015;5(1):81-5. PubMed PMID: 25941435.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute-on-Chronic Liver Failure: Recent Concepts. AU - Moreau,Richard, AU - Jalan,Rajiv, AU - Arroyo,Vicente, Y1 - 2014/10/03/ PY - 2014/07/10/received PY - 2014/09/07/accepted PY - 2015/5/6/entrez PY - 2015/5/6/pubmed PY - 2015/5/6/medline KW - ACLF, acute-on-chronic liver failure KW - AD, acute decompensation KW - CANONIC, Consortium Acute-on-Chronic Liver Failure in Cirrhosis KW - CLIF, chronic liver failure KW - CRP, C-reactive protein KW - EASL, European Association for the Study of the Liver KW - INR, international normalized ratio KW - SBP, spontaneous bacterial peritonitis KW - SOFA, sequential organ failure assessment KW - cirrhosis KW - inflammation KW - organ failures SP - 81 EP - 5 JF - Journal of clinical and experimental hepatology JO - J Clin Exp Hepatol VL - 5 IS - 1 N2 - 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 (<3 months). Moreover these patients with "early" ACLF were more severe than patients who developed ACLF after a long of history of decompensated cirrhosis. SN - 0973-6883 UR - https://www.unboundmedicine.com/medline/citation/25941435/Acute_on_Chronic_Liver_Failure:_Recent_Concepts_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0973-6883(14)00394-6 DB - PRIME DP - Unbound Medicine ER -
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