Patterns of acute decompensation in hospitalized patients with cirrhosis and course of acute‐on‐chronic liver failure

作者：Lorenz Balcar, Georg Semmler, Katharina Pomej, Benedikt Simbrunner, David Bauer, Lukas Hartl, Mathias Jachs, Rafael Paternostro, Theresa Bucsics, Matthias Pinter, Michael Trauner, Mattias Mandorfer, Thomas Reiberger, Bernhard Scheiner · 发表于：United European Gastroenterology Journal · 年份：2021 · DOI：10.1002/ueg2.12089 · 被引用次数：33 · 研究领域：Liver Disease and Transplantation、Nutrition and Health in Aging、Clinical Nutrition and Gastroenterology

INTRODUCTION: Recently, based on data from the PREDICT study, the European Foundation for the Study of Chronic Liver Failure (EF-CLIF) consortium proposed pathophysiological/prognostic groups in hospitalized patients with cirrhosis: stable decompensated cirrhosis (SDC), unstable decompensated cirrhosis (UDC), pre-acute-on-chronic liver failure (pre-ACLF), and ACLF. We evaluated the outcomes of these subgroups in a real-life cohort of hospitalized patients with cirrhosis. METHODS: Patients with cirrhosis developing first AD between 09/2010 and 12/2017 at the Vienna General Hospital were evaluated for this retrospective analysis. RESULTS: Two hundred and ten patients with cirrhosis (aged 57.6 ± 11.8 years) including n = 45 (21.4%) SDC, n = 100 (47.6%) UDC, n = 28 (13.3%) pre-ACLF, and n = 37 (17.6%) with ACLF were considered. The proposed AD subgroups discriminated between patients with favorable (1-year mortality: SDC: 6.7% and UDC: 19.6%) and dismal prognosis (90-day mortality: pre-ACLF: 42.9%). Interestingly, systemic inflammation gradually increased (e.g., C-reactive protein, SDC: 0.9 mg/dl, vs. UDC: 2.0 mg/dl vs. pre-ACLF: 3.2 mg/dl, p < 0.001) while renal function was progressively deteriorating (creatinine levels, SDC: 0.8 mg/dl vs. UDC: 0.9 mg/dl vs. pre-ACLF: 1.2 mg/dl, p < 0.001) across prognostic subgroups in patients with cirrhosis. DISCUSSION: The recently proposed pathophysiological/prognostic EF-CLIF subgroups are also reproduceable in a real-life cohort of cirrh...