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https://www.readbyqxmd.com/read/28930918/neutrophil-to-lymphocyte-ratio-predicts-death-in-acute-on-chronic-liver-failure-patients-admitted-to-the-intensive-care-unit-a-retrospective-cohort-study
#1
Nicolas Moreau, Xavier Wittebole, Yvan Fleury, Patrice Forget, Pierre-François Laterre, Castanares-Zapatero Diego
The neutrophil-to-lymphocyte ratio (NLR) is an inflammation score recognized as associated with outcome. While inflammation has been shown to correlate with the development of acute-on-chronic liver failure (ACLF), we sought to investigate the role of NLR in predicting 90-day mortality in cirrhotic patients experiencing ACLF.We performed a retrospective cohort study involving a total of 108 consecutive cirrhotic patients admitted in the intensive care unit (ICU). NLR, clinical and biological data were recorded...
September 19, 2017: Shock
https://www.readbyqxmd.com/read/28928275/development-of-diagnostic-criteria-and-a-prognostic-score-for-hepatitis-b-virus-related-acute-on-chronic-liver-failure
#2
Tianzhou Wu, Jiang Li, Li Shao, Jiaojiao Xin, Longyan Jiang, Qian Zhou, Dongyan Shi, Jing Jiang, Suwan Sun, Linfeng Jin, Ping Ye, Lingling Yang, Yinyun Lu, Tan Li, Jianrong Huang, Xiaowei Xu, Jiajia Chen, Shaorui Hao, Yuemei Chen, Shaojie Xin, Zhiliang Gao, Zhongping Duan, Tao Han, Yuming Wang, Jianhe Gan, Tingting Feng, Chen Pan, Yongping Chen, Hai Li, Yan Huang, Qing Xie, Shumei Lin, Lanjuan Li, Jun Li
OBJECTIVE: The definition of acute-on-chronic liver failure (ACLF) based on cirrhosis, irrespective of aetiology, remains controversial. This study aimed to clarify the clinicopathological characteristics of patients with hepatitis B virus-related ACLF (HBV-ACLF) in a prospective study and develop new diagnostic criteria and a prognostic score for such patients. DESIGN: The clinical data from 1322 hospitalised patients with acute decompensation of cirrhosis or severe liver injury due to chronic hepatitis B (CHB) at 13 liver centres in China were used to develop new diagnostic and prognostic criteria...
September 19, 2017: Gut
https://www.readbyqxmd.com/read/28921629/validation-of-prognostic-scores-to-predict-short-term-mortality-in-patients-with-acute-on-chronic-liver-failure
#3
Do Seon Song, Tae Yeob Kim, Dong Joon Kim, Hee Yeon Kim, Dong Hyun Sinn, Eileen L Yoon, Chang Wook Kim, Young Kul Jung, Ki Tae Suk, Sang Soo Lee, Chang Hyeong Lee, Tae Hun Kim, Won Hyeok Choe, Hyung Joon Yim, Sung Eun Kim, Soon Koo Baik, Jae Young Jang, Hyoung Su Kim, Sang Gyune Kim, Jin Mo Yang, Joo Hyun Sohn, Eun Hee Choi, Hyun Chin Cho, Soung Won Jeong, Moon Young Kim
BACKGROUND AND AIM: The aim of this study was to validate the Chronic Liver Failure-Sequential Organ Failure Assessment score (CLIF-SOFAs), CLIF consortium organ failure score (CLIF-C OFs), CLIF-C acute-on-chronic liver failure score (CLIF-C ACLFs), and CLIF-C acute decompensation score (CLIF-C ADs) in Korean chronic liver disease patients with acute deterioration. METHODS: ACLF was defined by either the Asian Pacific Association for the Study of the Liver ACLF Research Consortium (AARC) or CLIF-C criteria...
September 16, 2017: Journal of Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/28918795/-acute-on-chronic-liver-failure
#4
Nikolaj Worm Ørntoft, Karen Louise Thomsen, Gitte Dam, Niels Kristian Aagaard, Henning Grønbæk
Acute-on-chronic liver failure (ACLF) is a clinical syndrome characterized by acute decompensation of liver cirrhosis, organ failure and high short-term mortality (20-80% at one month). The main precipitants are infections and excessive alcohol intake, and the mechanistic features include a high level of systemic inflammation, macrophage activation and liver injury. The severity of ACLF is graded according to the number and extent of organ failures. Prognostic scores help predict mortality and support decisions on intensive treatment or futility...
September 18, 2017: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/28911947/albumin-prevents-infections-in-patients-with-chronic-liver-failure-in-a-single-arm-feasibility-trial
#5
Louise China, Simon S Skene, Zainib Shabir, Alexander Maini, Yvonne Sylvestre, Kate Bennett, Scott Bevan, James O'Beirne, Ewan Forrest, Jim Portal, Steve Ryder, Gavin Wright, Derek W Gilroy, Alastair O'Brien
BACKGROUND & AIMS: Infections are life threatening to patients with acute decompensation and acute-on-chronic liver failure (AD/ACLF). Patients with AD/ACLF have prostaglandin E2-mediated immune suppression, which can be reversed by administration of albumin; infusion of 20% human albumin solution (HAS) might improve outcomes of infections. We performed a feasibility study to determine optimal trial design, assess safety, and validate laboratory assessments of immune function to inform design of a phase 3 trial...
September 11, 2017: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/28906399/characteristics-of-infection-and-its-impact-on-short-term-outcome-in-patients-with-acute-on-chronic-liver-failure
#6
Junjun Cai, Mengchen Zhang, Tao Han, Hui-Qing Jiang
Bacterial infections are an important cause of mortality in liver failure. However, the type of infection, predictors of infection, and their impact on outcomes in patients with acute-on-chronic liver failure (ACLF) are limited.A total of 389 patients with ACLF were admitted in this retrospective, corhort study. Once admitted, clinical data including first infection site, type (community-acquired, healthcare-associated, or nosocomial), and second infection occurrence during hospitalization were collected. The outcome was mortality within 90 days...
September 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28901345/-acute-alcoholic-hepatitis
#7
Gianni Testino, Emanuele Scafato, Valentino Patussi
Chronic alcohol related liver disease is characterized by a cascade of events defined as follows: steatosis, steatohepatitis/steatofibrosi, cirrhosis and hepatocellular carcinoma. On one of these histologic patterns may overlap acute alcoholic hepatitis (AAE) (mild, moderate, severe). Severe AAE can cause a severe clinical picture: jaundice with a duration of less than three months, jaundice in the first decompensation event, serum bilirubin higher than 5 mg/dL, ratio AST/ALT >2:1, AST less than 500 IU/L ALT <300 IU/L, neutrophil leukocytosis and increased GGT...
September 2017: Recenti Progressi in Medicina
https://www.readbyqxmd.com/read/28895204/liver-transplantation-in-critically-ill-patients-preoperative-predictive-factors-of-post-transplant-mortality-to-avoid-futility
#8
Baptiste Michard, Thierry Artzner, Benjamin Lebas, Camille Besch, Max Guillot, François Faitot, François Lefebvre, Philippe Bachellier, Vincent Castelain, Quentin Maestraggi, Francis Schneider
Liver transplant (LT) is often the only life-saving therapeutic option for patients with acute liver failure (ALF) (i.e. without prior liver disease) and for acute-on-chronic liver failure (ACLF). With the progressive introduction of the model for end-stage liver disease (MELD) score in liver transplantation allocation algorithms (since 2007 in France), a new paradigm has begun to emerge based on the idea of prioritizing transplant allocations to patients who are more acutely ill and with the highest MELD scores...
September 12, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28879696/clinical-usefulness-of-measuring-red-blood-cell-distribution-width-in-patients-with-hepatitis-b-virus-related-acute-on-chronic-liver-failure
#9
Lei Jin, Yufeng Gao, Jun Ye, Guizhou Zou, Xu Li
BACKGROUND: The red blood cell distribution width (RDW) is increased in chronic liver disease, but its clinical significance in hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is still unclear. The aim of the present study was to investigate the clinical significance of RDW in HBV-ACLF patients. METHODS: The medical records of HBV-ACLF patients who were admitted to The Second Affiliated Hospital of Anhui Medical University between April 2012 and December 2015 were retrospectively reviewed...
September 1, 2017: Clinical Laboratory
https://www.readbyqxmd.com/read/28859868/albumin-counteracts-immune-suppressive-effects-of-lipid-mediators-in-patients-with-advanced-liver-disease
#10
Louise China, Alexander Maini, Simon S Skene, Zainib Shabir, Yvonne Sylvestre, Romain A Colas, Lucy Ly, Natalia Becares Salles, Vittorio Belloti, Jesmond Dalli, Derek W Gilroy, Alastair O'Brien
BACKGROUND & AIMS: Patients with acute decompensation and acute on chronic liver failure (AD/ACLF) have immune dysfunction, which increases their risk for infections; however there are no effective treatments to restore their immune function. We investigated whether the potentially immune-restorative effects of albumin are mediated by its effects on prostaglandin E2 (PGE2) and other lipids. METHODS: We analyzed bloods samples from 45 of 79 patients with AD/ACLF and serum levels of albumin less than 30g/L for whom infusion of 20% human albumin solution (HAS) increased serum levels of albumin 30 g/L or more in a feasibility study of effects of 20% HAS...
August 28, 2017: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/28856540/liver-failure-determines-the-outcome-in-patients-of-acute-on-chronic-liver-failure-aclf-comparison-of-apasl-aclf-research-consortium-aarc-and-clif-sofa-models
#11
A Choudhury, A Jindal, R Maiwall, M K Sharma, B C Sharma, V Pamecha, M Mahtab, S Rahman, Y K Chawla, S Taneja, S S Tan, H Devarbhavi, Z Duan, Chen Yu, Q Ning, Ji Dong Jia, D Amarapurkar, C E Eapen, A Goel, S S Hamid, A S Butt, W Jafri, D J Kim, H Ghazinian, G H Lee, Ajit Sood, L A Lesmana, Z Abbas, G Shiha, D A Payawal, A K Dokmeci, J D Sollano, G Carpio, G K Lau, F Karim, P N Rao, R Moreau, P Jain, P Bhatia, G Kumar, S K Sarin
BACKGROUND AND AIMS: Acute-on-chronic liver failure (ACLF) is a progressive disease associated with rapid clinical worsening and high mortality. Early prediction of mortality and intervention can improve patient outcomes. We aimed to develop a dynamic prognostic model and compare it with the existing models. METHODS: A total of 1402 ACLF patients, enrolled in the APASL-ACLF Research Consortium (AARC) with 90-day follow-up, were analyzed. An ACLF score was developed in a derivation cohort (n = 480) and was validated (n = 922)...
August 30, 2017: Hepatology International
https://www.readbyqxmd.com/read/28856287/acute-on-chronic-hepatitis-a-case-report-of-autoimmune-hepatitis-primary-sclerosing-cholangitis-ulcerative-colitis-overlap-syndrome-in-a-15-year-old-patient
#12
Aneta Nalepa, Małgorzata Woźniak, Joanna Cielecka-Kuszyk, Marek Stefanowicz, Irena Jankowska, Maciej Dądalski, Joanna Pawłowska
Acute-on-chronic liver failure (ACLF) is a disease in which a rapid deterioration of liver function occurs in patients with chronic liver disease, and is usually associated with a precipitating event. We present the case of a boy with autoimmune hepatitis/primary sclerosing cholangitis/ulcerative colitis (AIH/PSC/UC) overlap syndrome, in whom liver function was stable for 4.5 years of treatment. At 15 years of age the patient was hospitalized due to a deterioration of his general condition, severe abdominal pain, diarrhoea, vomiting and weight loss...
March 2017: Clin Exp Hepatol
https://www.readbyqxmd.com/read/28856003/sorafenib-induced-acute-on-chronic-liver-failure-in-a-patient-with-hepatocellular-carcinoma-after-transarterial-chemoembolization-and-radiofrequency-ablation-a-case-report
#13
Qing-Liang Wang, Xiao-Jie Li, Zhi-Cheng Yao, Peng Zhang, Shi-Lei Xu, He Huang, Kun-Peng Hu
Comprehensive treatments together with sorafenib provide a survival benefit for patients with advanced hepatocellular carcinoma (HCC). Acute-on-chronic liver failure (ACLF) is an increasingly recognized distinct entity; however, only few cases induced by sorafenib have been reported to date. We herein present a rare case of ACLF in a patient under treatment with sorafenib. A 63-year-old woman who suffered from hepatitis B for 10 years was admitted to our hospital. A computed tomography (CT) scan led to a diagnosis of HCC in the V/VIII hepatic segment, with invasion of the middle hepatic and the right portal veins...
October 2017: Molecular and Clinical Oncology
https://www.readbyqxmd.com/read/28853199/bacterial-infection-triggered-acute-on-chronic-liver-failure-is-associated-with-increased-mortality
#14
Marcus M Mücke, Tatiana Rumyantseva, Victoria T Mücke, Katharina Schwarzkopf, Sabrina Joshi, Volkhard A J Kempf, Christoph Welsch, Stefan Zeuzem, Christian M Lange
BACKGROUND & AIMS: Acute-on-chronic liver failure (ACLF) is characterized by an acute deterioration of liver function in patients with cirrhosis in combination with recently defined organ failures. Our aim was to independently validate the prognostic value of the recently established EASL-CLIF-Consortium definition of ACLF and to identify new predictors of short-term mortality. METHODS: Patients with cirrhosis and the International Classification of Diseases, Tenth Revision diagnosis of (sub)acute liver failure were retrospectively categorized according to the EASL-CLIF-Consortium definition...
August 29, 2017: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/28851246/single-center-validation-of-mortality-scores-in-patients-with-acute-decompensation-of-cirrhosis-with-and-without-acute-on-chronic-liver-failure
#15
Alexandra Alexopoulou, Larisa Vasilieva, Iliana Mani, Danai Agiasotelli, Helen Pantelidaki, Spyros P Dourakis
OBJECTIVES: Acute decompensation (AD) of cirrhosis is characterized by high mortality. We aimed to validate the performance in predicting mortality of both the chronic-liver-failure-consortium (CLIF-C) acute-on-chronic liver failure (ACLF) and CLIF-C AD scores in a cohort of patients admitted for AD. METHODS: In this prospective cohort study, patients were followed-up during their hospital stay and for 365 days thereafter. RESULTS: About 182 patients with AD were enrolled including 78 (42...
August 29, 2017: Scandinavian Journal of Gastroenterology
https://www.readbyqxmd.com/read/28844314/acute-kidney-injury-in-acute-on-chronic-liver-failure-where-does-hepatorenal-syndrome-fit
#16
REVIEW
Andrew Davenport, Mohammed Faisal Sheikh, Edmund Lamb, Banwari Agarwal, Rajiv Jalan
Renal dysfunction occurs in 25% to 50% of patients with cirrhosis admitted to the hospital with an acute episode of hepatic decompensation and may be due to underlying chronic kidney disease, an acute deterioration, or both. An acute deterioration in renal function in cirrhotic patients is now collectively referred to as acute kidney injury (AKI), which has been subclassified into different grades of severity that identify prognostic groups. Acute-on-chronic liver failure is characterized by acute hepatic and/or extrahepatic organ failure driven by a dysregulated immune response and systemic inflammatory response...
August 23, 2017: Kidney International
https://www.readbyqxmd.com/read/28843665/balanced-haemostasis-with-both-hypo-and-hyper-coagulable-features-in-critically-ill-patients-with-acute-on-chronic-liver-failure
#17
Caleb Fisher, Vishal C Patel, Sidsel Hyldgaard Stoy, Arjuna Singanayagam, Jelle Adelmeijer, Julia Wendon, Debbie L Shawcross, Ton Lisman, William Bernal
BACKGROUND: Cirrhotic patients have complex haemostatic abnormalities. Current evidence suggests stable cirrhotic (SC) patients have a "re-balanced" haemostatic state. However, limited data exists in acute decompensated (AD) or acute on chronic liver failure (ACLF) patients. METHODS: We utilised thrombin generation analysis, fibrinolysis assessment, and evaluation of haemostatic parameters to assess haemostasis in liver disease of progressive severity. RESULTS: The study cohorts were comprised of: SC, n=8; AD n=44; ACLF, n=17; and Healthy Control (HC), n=35...
August 17, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28840583/therapeutic-implications-of-granulocyte-colony-stimulating-factor-in-patients-with-acute-on-chronic-liver-failure-increased-survival-and-containment-of-liver-damage
#18
Biplob Kumar Saha, Mamun Al Mahtab, Sheikh Mohammad Fazle Akbar, Sheikh Mohammad Noor-E-Alam, Ayub Al Mamun, Sharker Mohammad Shahadat Hossain, Mohammad Ashraful Alam, Ahmed Lutful Moben, Faiz Ahmad Khondaker, Forhadul Islam Chowdhury, Ruksana Raihan, Salimur Rahman, Ashok Kumar Choudhury
BACKGROUND AND PURPOSE: Mobilization of bone marrow-derived stem cells by granulocyte colony stimulating factor (G-CSF) supports hepatic regeneration and may augment clinical improvement in patients with acute-on-chronic liver failure (ACLF). The aim of this study is to assess the impact of G-CSF on complications and transplant-free survival in patients with ACLF. METHODS: Thirty-two patients with ACLF defined by Asian Pacific Association for the Study of the Liver (APASL) criteria were openly randomized to control (group A) or intervention (group B) receiving G-CSF (5 μg/kg/day, for 6 consecutive days) in addition to standard medical therapy with antiviral drugs...
August 24, 2017: Hepatology International
https://www.readbyqxmd.com/read/28818763/the-qualitative-and-quantitative-image-analysis-of-mr-imaging-in-patients-with-acute-on-chronic-liver-failure
#19
Tae Wook Kang, Mimi Kim, Young Kon Kim, Seong Hyun Kim, Dong Hyun Sinn, Kyunga Kim
PURPOSE: To evaluate the distinctive features of ACLF and chronic liver disease (CLD) on MR images using quantitative and qualitative analyses. METHODS: Twelve patients with ACLF and 36 patients with CLD who had undergone MR images were included. MR imaging findings from both groups were assessed. RESULTS: Gallbladder edema, esophageal varix, and ascites were significantly more prevalent in the ACLF group (all P-values <0.05). The liver to muscle SI ratio on T2-WI was significantly higher in the ACLF group (P=0...
August 10, 2017: Clinical Imaging
https://www.readbyqxmd.com/read/28811718/chronic-liver-failure-consortium-acute-on-chronic-liver-failure-and-acute-decompensation-scores-predict-mortality-in-brazilian-cirrhotic-patients
#20
Rafael Veiga Picon, Franciele Sabadin Bertol, Cristiane Valle Tovo, Ângelo Zambam de Mattos
AIM: To validate prognostic scores for acute decompensation of cirrhosis and acute-on-chronic liver failure in Brazilian patients. METHODS: This is a prospective cohort study designed to assess the prognostic performance of the chronic liver failure-consortium (CLIF-C) acute decompensation score (CLIF-C AD) and CLIF-C acute-on-chronic liver failure score (CLIF-C ACLF), regarding 28-d and 90-d mortality, as well as to compare them to other prognostic models, such as Model for End-Stage Liver Disease (MELD), MELD Sodium (MELD-Na), Child-Pugh (CP) score, and the CLIF-C Organ Failure score (CLIF-C OF)...
July 28, 2017: World Journal of Gastroenterology: WJG
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