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Jiangshan Lian, Xiaofen Li, Yinyin Wang, Jianle Yang, Wei Liu, Jing Ma, Deying Chen, Lanjuan Li, Jianrong Huang
OBJECTIVE: The present study aims to compare serum metabolite alterations between acute-on-chronic liver failure (ACLF) and chronic liver failure (CLF), and find the specific biomarkers associated with the diseases. METHODS: Serum samples were collected from patients with ACLF (n=76) and CLF (n=56) as well as healthy individuals (n=20) and assayed by ultra-performance liquid chromatography mass spectrometry (UPLC-MS). The acquired data was analyzed using principal components analysis (PCA) and partial least squares discriminate analysis (PLS-DA)...
October 18, 2016: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
Kristine M Fischenich, Hannah M Pauly, Keith D Button, Ryan S Fajardo, Charles E DeCamp, Roger C Haut, Tammy L Haut Donahue
OBJECTIVE: The objective of this study was to monitor the progression of joint damage in two animal models of knee joint trauma using two non-invasive, clinically available imaging modalities. METHODS: A 3-T clinical magnet and micro-computed tomography was used to document changes immediately following injury (acute) and post injury (chronic) at time points of 4, 8, or 12 weeks. Joint damage was recorded at dissection and compared to the chronic MRI record. Fifteen Flemish Giant rabbits were subjected to a single tibiofemoral compressive impact (ACLF), and 18 underwent a combination of ACL and meniscal transection (mACLT)...
October 15, 2016: Osteoarthritis and Cartilage
Antonella Putignano, Thierry Gustot
Acute-on-Chronic Liver Failure (ACLF) is a recently defined syndrome that occurs frequently in patients with cirrhosis and is associated with a poor short-term prognosis. Currently, management of patients with ACLF is mainly supportive. Despite medical progress, this syndrome frequently leads to multi-organ failure, sepsis, and, ultimately, death. The results of attempts to use liver transplantation (LT) to manage this critical condition have been poorly reported but are promising. Currently, selection criteria of ACLF patients for LT, instructions for prioritization on the waiting list, and objective indicators for removal of ACLF patients from the waiting list in cases of clinical deterioration are poorly defined...
October 17, 2016: Liver Transplantation
Xiaoshu Li, Fangyuan Gao, Huimin Liu, Henghui Zhang, Yao Liu, Xieqiong Ye, Mingfan Geng, Le Sun, Rui Wang, Yuxin Li, Yuyong Jiang, Xiaojing Wang, Guiqin Zhou, Zhiyun Yang, Ang Li, Hui Zeng, Xianbo Wang
AIM: Hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) has significant morbidity and mortality. There is no standard approach for the management of HBV-related ACLF with nucleos(t)ide analogs. Our objective was to compare the short-term mortality between entecavir (ETV) and lamivudine (LAM) in patients with HBV-related ACLF. METHODS: We recruited 311 inpatients with HBV-related ACLF from December 2002 to January 2015. The patients were treated with ETV (n=143) or LAM (n=168)...
October 4, 2016: European Journal of Gastroenterology & Hepatology
Shiv Kumar Sarin, Ashok Choudhury
Acute-on-chronic liver failure (ACLF) is a distinct entity that differs from acute liver failure and decompensated cirrhosis in timing, presence of treatable acute precipitant, and course of disease, with a potential for self-recovery. The core concept is acute deterioration of existing liver function in a patient of chronic liver disease with or without cirrhosis in response to an acute insult. The insult should be a hepatic one and presentation in the form of liver failure (jaundice, encephalopathy, coagulopathy, ascites) with or without extrahepatic organ failure in a defined time frame...
December 2016: Current Gastroenterology Reports
Anil C Anand, Radha K Dhiman
Acute on chronic liver failure (ACLF) is a recently recognized syndrome and its definition has been evolving over last two decades. Currently, there is no universal consensus about the definition as kind of cases being seen in the Western world appear to be somewhat different from those that are seen in Asia Pacific region. But every one agrees that definition of ACLF should include following components. (a) The status of pre-existing liver disease, (b) defining the acute insult that leads to rapid deterioration of liver status, (c) time frame during which the acute insult can lead to rapid deterioration, (d) the quantification and definition of liver failure status after deterioration, which will determine the severity of ACLF, and (e) prediction of prognosis after analyzing first four components in the short and long terms...
September 2016: Journal of Clinical and Experimental Hepatology
Nicolas Weiss, Matteo Rosselli, Sarah Mouri, Damien Galanaud, Louis Puybasset, Banwari Agarwal, Dominique Thabut, Rajiv Jalan
Although hepatic encephalopathy (HE) on the background of acute on chronic liver failure (ACLF) is associated with high mortality rates, it is unknown whether this is due to increased blood-brain barrier permeability. Specific gravity of cerebrospinal fluid measured by CT is able to estimate blood-cerebrospinal fluid-barrier permeability. This study aimed to assess cerebrospinal fluid specific gravity in acutely decompensated cirrhosis and to compare it in patients with or without ACLF and with or without hepatic encephalopathy...
October 11, 2016: Metabolic Brain Disease
Yuan Xue, Ming-Jie Wang, Su-Yuan Huang, Zhi-Tao Yang, De-Min Yu, Yue Han, Ming-Yu Zhu, Dao Huang, Dong-Hua Zhang, Qi-Ming Gong, Xin-Xin Zhang
BACKGROUND: CpG islands in hepatitis B virus (HBV) genome are potential targets for methylation mediated gene silencing, and may be involved in the pathogenesis of HBV infection. To date, their characteristics in HBV quasispecies (QS) remain largely unknown. The purpose of this study was to investigate the characteristics of CpG islands in HBV QS. METHODS: Forty patients diagnosed as acute hepatitis B (AHB, n = 10), immune-tolerant HBV carriers (IT, n = 9), chronic hepatitis B (CHB, n = 11), or acute on chronic liver failure (ACLF, n = 10), were enrolled in this case-control study...
2016: SpringerPlus
Patricia Huelin, Salvatore Piano, Elsa Solà, Marialuisa Stanco, Cristina Solé, Rebeca Moreira, Elisa Pose, Silvano Fasolato, Nuria Fabrellas, Glòria de Prada, Chiara Pilutti, Isabel Graupera, Xavier Ariza, Antonietta Romano, Chiara Elia, Andrés Cárdenas, Javier Fernández, Paolo Angeli, Pere Ginès
BACKGROUND & AIMS: In patients with cirrhosis of the liver, acute kidney injury (AKI) is classified into 3 stages. Recent studies indicate that there are 2 subgroups of stage 1 disease, associated with different outcomes and serum levels of creatinine (sCr): stage 1A (sCr <1.5 mg/dL) and stage 1B (SCr ≥1.5 mg/dL). We performed a prospective study to validate, in a large series of patients with cirrhosis, the association between this new description and patient outcomes, as well as assess the relationship between AKI stage and the presence of acute-on-chronic liver failure (ACLF)...
October 5, 2016: Clinical Gastroenterology and Hepatology
Alina M Allen, W Ray Kim, James P Moriarty, Nilay D Shah, Joseph J Larson, Patrick S Kamath
: Acute on chronic liver failure (ACLF) is associated with multi-system organ failure and poor prognosis in hospitalized patients with cirrhosis. We aimed to determine time trends in the epidemiology, economic burden and mortality of ACLF in the United States. The National Inpatient Sample database was queried between 2001 and 2011. ACLF was defined as 2 or more extrahepatic organ failures in patients with cirrhosis. The primary outcomes were trends in hospitalizations, hospital costs and inpatient mortality in ACLF...
October 3, 2016: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Yu-Hua Li, Ying Xu, Hua-Mei Wu, Jing Yang, Li-Hong Yang, Wan Yue-Meng
BACKGROUND & AIM: Search for an effective therapy for patients with hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) remains an important issue. This study investigated the efficacy of umbilical cord-derived mesenchymal stem cell (UC-MSC) transplantation in patients with HBV-ACLF. METHODS: 45 consecutive entecavir-treated HBV-ACLF patients were prospectively studied. Among these patients, 11 received both plasma exchange (PE) and a single transplantation of UC-MSCs (group A), while 34 received only PE (group B)...
September 29, 2016: Stem Cell Reviews
X Li, C Gou, L Yao, Z Lei, T Gu, F Ren, T Wen
Acute-on-chronic liver failure (ACLF) is the most common type of liver failure and associated with grave consequences. Systemic inflammation has been linked to its pathogenesis and outcome, but the identifiable triggers are absent. Recently, extracellular histones, especially H4, have been recognized as important mediators of cell damage in various inflammatory conditions. This study aimed to investigate whether extracellular histones have clinical implications in patients with hepatitis B virus (HBV)-related ACLF...
September 23, 2016: Journal of Viral Hepatitis
Yi Shen, Xulin Wang, Sheng Zhang, Gang Qin, Yanmei Liu, Yihua Lu, Feng Liang, Xun Zhuang
This research utilized an external longitudinal dataset of hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) to compare and validate various predictive models that support the current recommendations to select the most effective predictive risk models to estimate short- and long-term mortality and facilitate decision-making about preferable therapeutics for HBV-ACLF patients. Twelve ACLF prognostic models were developed after a systematic literature search using the longitudinal data of 232 HBV-ACLF patients on the waiting list for liver transplantation (LT)...
2016: Scientific Reports
Dinesh Kumar, Gaurav Pandey, Deepak Bansal, Atul Rawat, Umesh Kumar, Durgesh Dubey, Anupam Guleria, Vivek Anand Saraswat
The article presents a simplified NMR based protocol for urinary profiling of lactulose/mannitol ratio (LMR) and demonstrates here its utility to assess increased intestinal permeability (IP) in patients with acute on chronic liver failure (ACLF). ACLF is a serious clinical complication associated with chronic liver disease (cirrhosis). The major risk factor in its development is increased IP ("leaky gut") which has been linked to disease progression and to infectious complications. However, IP has seldom been investigated in patients with ACLF, even though patients frequently report gastrointestinal disorders and associated complications...
September 14, 2016: Magnetic Resonance in Chemistry: MRC
Cristina Solé, Elsa Solà, Manuel Morales-Ruiz, Guerau Fernàndez, Patricia Huelin, Isabel Graupera, Rebeca Moreira, Gloria de Prada, Xavier Ariza, Elisa Pose, Núria Fabrellas, Susana G Kalko, Wladimiro Jiménez, Pere Ginès
ACLF is characterized by a systemic inflammatory response, but the cytokines involved in this process have not been well studied. The aim of this study was to characterize the systemic inflammatory response in patients with cirrhosis and ACLF and its relationship with prognosis. Fifty-five patients with cirrhosis, 26 with ACLF, were studied prospectively. Systemic inflammatory response was analyzed by measuring a large array of plasma cytokines by using a multiplex kit. A principal component analysis show noticeable differences between ACLF and decompensated cirrhosis without ACLF...
2016: Scientific Reports
Yue Luo, Yun Xu, Mingming Li, Ya Xie, Guozhong Gong
Hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) is one of the most deadly diseases. Many models have been proposed to evaluate the prognosis of it. However, these models are still controversial. In this study, we aimed to incorporate some characters into model for end-stage liver disease (MELD) to establish a new reliable and feasible model for the prognosis of HBV-ACLF.A total of 530 HBV-ACLF patients who had received antiviral therapy were enrolled into a retrospective study and divided into the training cohort (300) and validation cohort (230)...
August 2016: Medicine (Baltimore)
Ruidong Mo, Peng Wang, Rongtao Lai, Fanlu Li, Yuhan Liu, Shaowen Jiang, Gangde Zhao, Simin Guo, Huijuan Zhou, Lanyi Lin, Jie Lu, Wei Cai, Hui Wang, Hong Yu, Shisan Bao, Xiaogang Xiang, Qing Xie
BACKGROUND AND AIM: Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is an acute deterioration of liver function on chronic liver disease with immune disorder. Th22 cells and IL-22 were correlated with inflammatory and autoimmune diseases. However Th22 cells and IL-22 in the pathogenesis of HBV-ACLF remains to be elucidated. It was investigated the correlation between Th22 and prognosis in HBV-ACLF. METHODS: Seventy-one HBV-ACLF and 65 chronic hepatitis B patients were recruited...
August 22, 2016: Journal of Gastroenterology and Hepatology
Hong Zang, Fangfang Liu, Hongling Liu, Shaoli You, Bing Zhu, Zhihong Wan, Shaojie Xin
BACKGROUND AND AIMS: Acute kidney injury (AKI) is a life-threatening complication in patients with acute-on-chronic liver failure (ACLF) of underlying cirrhosis. However, the characteristics of AKI in these patients have not been clarified. Our aim was to determine the incidence and risk factors of AKI and the association between AKI severity and 180-day transplant-free survival. METHODS: We performed a retrospective cohort analysis of patients with ACLF of underlying cirrhosis in a single center from January 2009 through December 2014...
September 2016: Hepatology International
Tony Bruns, Renwar Nuraldeen, Martina Mai, Sven Stengel, Henning W Zimmermann, Eray Yagmur, Christian Trautwein, Andreas Stallmach, Pavel Strnad
BACKGROUND & AIMS: Iron represents an essential, but potentially harmful micronutrient, whose regulation has been associated with poor outcome in liver disease. Its homeostasis is tightly linked to oxidative stress, bacterial infections and systemic inflammation. To study the prognostic short-term significance of iron parameters in a cohort study of patients with decompensation of cirrhosis at risk of acute-on-chronic liver failure (ACLF). METHODS: Ferritin, transferrin, iron, transferrin saturation (TSAT) and hepcidin were determined in sera from 292 German patients hospitalized for decompensation of cirrhosis with ascites, of which 78 (27%) had ACLF...
July 30, 2016: Liver International: Official Journal of the International Association for the Study of the Liver
H Y Zhang, G J Xie, Q Chen, B Zhao, Q Mao, X Q Zhang
OBJECTIVE: To investigate the diagnostic criteria for HBV-related acute-on-chronic pre-liver failure (pre-ACLF) which can effectively predict the risk of liver failure. METHODS: A total of 1279 patients with severe icteric chronic hepatitis B (CHB) and/or severe acute exacerbation of CHB were enrolled. The influence of serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TBil), international normalized ratio (INR) of prothrombin time, sex, and age on the incidence rate of acute-on-chronic liver failure (ACLF) was analyzed, the diagnostic criteria for pre-ACLF and predictive model for ACLF were developed...
May 20, 2016: Zhonghua Gan Zang Bing za Zhi, Zhonghua Ganzangbing Zazhi, Chinese Journal of Hepatology
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