The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology
Trebicka, Jonel (JW Goethe University Hospital)
Fernández, Javier (Hospital Clínic i Provincial de Barcelona)
Papp, Maria (University of Debrecen)
Caraceni, Paolo (University of Bologna)
Laleman, Wim (University of Leuven)
Gambino, Carmine (University of Padova)
Giovo, Ilaria (University of Torino)
Uschner, Frank Erhard (JW Goethe University Hospital)
Jiménez, Cesar (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Mookerjee, Rajeshwar Prosad (UCL Royal Free Hospital)
Gustot, Thierry (Universite Libre de Bruxelles)
Albillos, Agustín (Instituto Ramón y Cajal de Investigación Sanitaria (Madrid))
Bañares, Rafael (Universidad Complutense de Madrid)
Janicko, Martin (Pavol Jozef Safarik University in Kosice)
Steib, Christian (University Hospital Munich)
Reiberger, Thomas (Medical University of Vienna)
Acevedo, Juan (University Hospitals Plymouth NHS Trust (Regne Unit))
Gatti, Pietro (Internal Medicine PO Ostuni. ASL Brindisi)
Bernal, William (King's College Hospital NHS Foundation Trust)
Zeuzem, Stefan (JW Goethe University Hospital)
Zipprich, Alexander (University Hospital Halle-Wittenberg)
Piano, Salvatore (University of Padova)
Berg, Thomas (Leipzig University)
Bruns, Tony (Aachen University Hospital)
Bendtsen, Flemming (Hvidovre University Hospital)
Coenraad, Minneke (Leiden University Medical Center)
Merli, Manuela (Universitá Sapienza Roma)
Stauber, Rudolf (Medical University of Graz)
Zoller, Heinz (Medical University of Innsbruck)
Presa Ramos, José (CHTMAD Vila Real)
Solé, Cristina (Hospital Clínic i Provincial de Barcelona)
Soriano, German (Institut d'Investigació Biomèdica Sant Pau)
De Gottardi, Andrea (Universita della Svizzera Italiana)
Gronbaek, Henning (Aarhus University Hospital (Aarhus, Dinamarca))
Saliba, Faouzi (AP-HP Hôpital Paul Brousse)
Trautwein, Christian (Aachen University Hospital)
Özdogan, Osman Cavit (Marmara University)
Francque, Sven (University Hospital Antwerp)
Ryder, Stephen David (University of Nottingham)
Nahon, Pierre (AP-HP. Hôpital Jean Verdier)
Romero-Gómez, Manuel (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Van Vlierberghe, Hans (Universitair Ziekenhuis Gent)
Francoz, Claire (Université de Paris)
Manns, Michael (Hannover Medical School)
García López, Elisabet (European Foundation for Study of Chronic Liver Failure. EF-Clif)
Tufoni, Manuel (University of Bologna)
Amoros, Alex (European Foundation for Study of Chronic Liver Failure. EF-Clif)
Pavesi, Marco (European Foundation for Study of Chronic Liver Failure. EF-Clif)
Sanchez, Cristina (European Foundation for Study of Chronic Liver Failure. EF-Clif)
Curto, Anna (European Foundation for Study of Chronic Liver Failure. EF-Clif)
Pitarch, Carla (European Foundation for Study of Chronic Liver Failure. EF-Clif)
Putignano, Antonella (Universite Libre de Bruxelles)
Moreno, Esau (European Foundation for Study of Chronic Liver Failure. EF-Clif)
Shawcross, Debbie (King's College Hospital NHS Foundation Trust)
Aguilar, Ferran (European Foundation for Study of Chronic Liver Failure. EF-Clif)
Clària, J (Hospital Clínic i Provincial de Barcelona)
Ponzo, Paola (University of Torino)
Jansen, Christian (University Hospital Bonn (Bonn, Alemanya))
Vitalis, Zsuzsanna (University of Debrecen)
Zaccherini, Giacomo (University of Bologna)
Balogh, Boglarka (University of Debrecen)
Vargas Blasco, Víctor (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Montagnese, Sara (University of Padova)
Alessandria, Carlo (University of Torino)
Bernardi, Mauro (University of Bologna)
Ginès, Pere (Hospital Clínic i Provincial de Barcelona)
Jalan, Rajiv (UCL Medical School. Royal Free Hospital)
Moreau, Richard (Université de Paris)
Angeli, Paolo (University of Padova)
Arroyo, Vicente (European Foundation for Study of Chronic Liver Failure. EF-Clif)
Maschmeier, Miriam (PREDICT STUDY group of the EASL-CLIF Consortium)
Semela, David (PREDICT STUDY group of the EASL-CLIF Consortium)
Elkrief, Laure (PREDICT STUDY group of the EASL-CLIF Consortium)
Elsharkawy, Ahmed (PREDICT STUDY group of the EASL-CLIF Consortium)
Tornai, Tamás (PREDICT STUDY group of the EASL-CLIF Consortium)
Tornai, Istvan (PREDICT STUDY group of the EASL-CLIF Consortium)
Altorjay, Istvan (PREDICT STUDY group of the EASL-CLIF Consortium)
Antognoli, Agnese (PREDICT STUDY group of the EASL-CLIF Consortium)
Baldassarre, Maurizio (PREDICT STUDY group of the EASL-CLIF Consortium)
Gagliardi, Martina (PREDICT STUDY group of the EASL-CLIF Consortium)
Bertoli, Eleonora (PREDICT STUDY group of the EASL-CLIF Consortium)
Mareso, Sara (PREDICT STUDY group of the EASL-CLIF Consortium)
Brocca, Alessandra (PREDICT STUDY group of the EASL-CLIF Consortium)
Campion, Daniela (PREDICT STUDY group of the EASL-CLIF Consortium)
Saracco, Giorgio Maria (PREDICT STUDY group of the EASL-CLIF Consortium)
Rizzo, Martina (PREDICT STUDY group of the EASL-CLIF Consortium)
Lehmann, Jennifer (PREDICT STUDY group of the EASL-CLIF Consortium)
Pohlmann, Alessandra (PREDICT STUDY group of the EASL-CLIF Consortium)
Praktiknjo, Michael (PREDICT STUDY group of the EASL-CLIF Consortium)
Schierwagen, Robert (PREDICT STUDY group of the EASL-CLIF Consortium)
Solà, Elsa (PREDICT STUDY group of the EASL-CLIF Consortium)
Amari, Nesrine (PREDICT STUDY group of the EASL-CLIF Consortium)
Rodriguez, Miguel (PREDICT STUDY group of the EASL-CLIF Consortium)
Nevens, Frederik (PREDICT STUDY group of the EASL-CLIF Consortium)
Clemente, Ana (PREDICT STUDY group of the EASL-CLIF Consortium)
Jarcuska, Peter (PREDICT STUDY group of the EASL-CLIF Consortium)
Gerbes, Alexander L. (PREDICT STUDY group of the EASL-CLIF Consortium)
Mandorfer, Mattias (PREDICT STUDY group of the EASL-CLIF Consortium)
Welsch, Christoph (PREDICT STUDY group of the EASL-CLIF Consortium)
Ciraci, Emanuela (PREDICT STUDY group of the EASL-CLIF Consortium)
Patel, Vish (PREDICT STUDY group of the EASL-CLIF Consortium)
Ripoll, Cristina (PREDICT STUDY group of the EASL-CLIF Consortium)
Herber, Adam (PREDICT STUDY group of the EASL-CLIF Consortium)
Horn, Paul (PREDICT STUDY group of the EASL-CLIF Consortium)
Danielsen, Karen Vagner (PREDICT STUDY group of the EASL-CLIF Consortium)
Gluud, Lise Lotte (PREDICT STUDY group of the EASL-CLIF Consortium)
Schaapman, Jelte (PREDICT STUDY group of the EASL-CLIF Consortium)
Riggio, Oliviero (PREDICT STUDY group of the EASL-CLIF Consortium)
Rainer, Florian (PREDICT STUDY group of the EASL-CLIF Consortium)
Moritz, Jörg Tobiasch (PREDICT STUDY group of the EASL-CLIF Consortium)
Mesquita, Mónica (PREDICT STUDY group of the EASL-CLIF Consortium)
Alvarado-Tapias, Edilmar (Institut d'Investigació Biomèdica Sant Pau)
Akpata, Osagie (PREDICT STUDY group of the EASL-CLIF Consortium)
Lykke Eriksen, Peter (PREDICT STUDY group of the EASL-CLIF Consortium)
Samuel, Didier (PREDICT STUDY group of the EASL-CLIF Consortium)
Tresson, Sylvie (PREDICT STUDY group of the EASL-CLIF Consortium)
Strnad, Pavel (PREDICT STUDY group of the EASL-CLIF Consortium)
Amathieu, Roland (PREDICT STUDY group of the EASL-CLIF Consortium)
Simón-Talero, Macarena (PREDICT STUDY group of the EASL-CLIF Consortium)
Smits, Francois (PREDICT STUDY group of the EASL-CLIF Consortium)
van den Ende, Natalie (PREDICT STUDY group of the EASL-CLIF Consortium)
Martinez, Javier (PREDICT STUDY group of the EASL-CLIF Consortium)
Garcia, Rita (PREDICT STUDY group of the EASL-CLIF Consortium)
Markwardt, Daniel (PREDICT STUDY group of the EASL-CLIF Consortium)
Rupprechter, Harald (PREDICT STUDY group of the EASL-CLIF Consortium)
Engelmann, Cornelius (PREDICT STUDY group of the EASL-CLIF Consortium)
Universitat Autònoma de Barcelona

Data:	2020
Resum:	Acute decompensation (AD) of cirrhosis is defined as the acute development of ascites, gastrointestinal hemorrhage, hepatic encephalopathy, infection or any combination thereof, requiring hospitalization. The presence of organ failure(s) in patients with AD defines acute-on-chronic liver failure (ACLF). The PREDICT study is a European, prospective, observational study, designed to characterize the clinical course of AD and to identify predictors of ACLF. A total of 1,071 patients with AD were enrolled. We collected detailed pre-specified information on the 3-month period prior to enrollment, and clinical and laboratory data at enrollment. Patients were then closely followed up for 3 months. Outcomes (liver transplantation and death) at 1 year were also recorded. Three groups of patients were identified. Pre-ACLF patients (n = 218) developed ACLF and had 3-month and 1-year mortality rates of 53. 7% and 67. 4%, respectively. Unstable decompensated cirrhosis (UDC) patients (n = 233) required ≥1 readmission but did not develop ACLF and had mortality rates of 21. 0% and 35. 6%, respectively. Stable decompensated cirrhosis (SDC) patients (n = 620) were not readmitted, did not develop ACLF and had a 1-year mortality rate of only 9. 5%. The 3 groups differed significantly regarding the grade and course of systemic inflammation (high-grade at enrollment with aggravation during follow-up in pre-ACLF; low-grade at enrollment with subsequent steady-course in UDC; and low-grade at enrollment with subsequent improvement in SDC) and the prevalence of surrogates of severe portal hypertension throughout the study (high in UDC vs. low in pre-ACLF and SDC). Acute decompensation without ACLF is a heterogeneous condition with 3 different clinical courses and 2 major pathophysiological mechanisms: systemic inflammation and portal hypertension. Predicting the development of ACLF remains a major future challenge. ClinicalTrials. gov number: NCT03056612. Lay summary: Herein, we describe, for the first time, 3 different clinical courses of acute decompensation (AD) of cirrhosis after hospital admission. The first clinical course includes patients who develop acute-on-chronic liver failure (ACLF) and have a high short-term risk of death - termed pre-ACLF. The second clinical course (unstable decompensated cirrhosis) includes patients requiring frequent hospitalizations unrelated to ACLF and is associated with a lower mortality risk than pre-ACLF. Finally, the third clinical course (stable decompensated cirrhosis), includes two-thirds of all patients admitted to hospital with AD - patients in this group rarely require hospital admission and have a much lower 1-year mortality risk.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Acute complications ; Chronic liver disease ; Non-elective admission ; Outcome ; Risk factors
Publicat a:	Journal of Hepatology, Vol. 73 Núm. 4 (october 2020) , p. 842-854, ISSN 1600-0641

DOI: 10.1016/j.jhep.2020.06.013
PMID: 32673741

14 p, 1.0 MB

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