PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Trebicka Jonel, Fernandez Javier, Papp Maria, Caraceni Paolo, Laleman Wim, Gambino Carmine, Giovo Ilaria, Uschner Frank Erhard, Jansen Christian, Jimenez Cesar, Mookerjee Rajeshwar, Gustot Thierry, Albillos Agustin, Bañares Rafael, Jarcuska Peter, Steib Christian, Reiberger Thomas, Acevedo Juan, Gatti Pietro, Shawcross Debbie L, Zeuzem Stefan, Zipprich Alexander, Piano Salvatore, Berg Thomas, Bruns Tony, Danielsen Karen Vagner, Coenraad Minneke, Merli Manuela, Stauber Rudolf, Zoller Heinz, Ramos José Presa, Solé Cristina, Soriano Germán, de Gottardi Andrea, Gronbaek Henning, Saliba Faouzi, Trautwein Christian, Kani Haluk Tarik, Francque Sven, Ryder Stephen, Nahon Pierre, Romero-Gomez Manuel, Van Vlierberghe Hans, Francoz Claire, Manns Michael, Garcia-Lopez Elisabet, Tufoni Manuel, Amoros Alex, Pavesi Marco, Sanchez Cristina, Praktiknjo Michael, Curto Anna, Pitarch Carla, Putignano Antonella, Moreno Esau, Bernal William, Aguilar Ferran, Clària Joan, Ponzo Paola, Vitalis Zsuzsanna, Zaccherini Giacomo, Balogh Boglarka, Gerbes Alexander, Vargas Victor, Alessandria Carlo, Bernardi Mauro, Ginès Pere, Moreau Richard, Angeli Paolo, Jalan Rajiv, Arroyo Vicente, PREDICT STUDY group of the EASL-CLIF CONSORTIUM
Аннотация
METHODS: The multicenter, prospective, observational PREDICT study (NCT03056612) included 1,273 non-electively hospitalized patients with AD (No ACLF = 1,071; ACLF = 202). Medical history, clinical data and laboratory data were collected at enrolment and during 90-day follow-up, with particular attention given to the following characteristics of precipitants: induction of organ dysfunction or failure, systemic inflammation, chronology, intensity, and relationship to outcome.
RESULTS: Among various clinical events, 4 distinct events were precipitants consistently related to AD: proven bacterial infections, severe alcoholic hepatitis, gastrointestinal bleeding with shock and toxic encephalopathy. Among patients with precipitants in the AD-No ACLF cohort and the AD-ACLF cohort (38% and 71%, respectively), almost all (96% and 97%, respectively) showed proven bacterial infection and severe alcoholic hepatitis, either alone or in combination with other events. Survival was similar in patients with proven bacterial infections or severe alcoholic hepatitis in both AD phenotypes. The number of precipitants was associated with significantly increased 90-day mortality and was paralleled by increasing levels of surrogates for systemic inflammation. Importantly, adequate first-line antibiotic treatment of proven bacterial infections was associated with a lower ACLF development rate and lower 90-day mortality.
CONCLUSIONS: This study identified precipitants that are significantly associated with a distinct clinical course and prognosis in patients with AD. Specific preventive and therapeutic strategies targeting these events may improve outcomes in patients with decompensated cirrhosis.
LAY SUMMARY: Acute decompensation (AD) of cirrhosis is characterized by a rapid deterioration in patient health. Herein, we aimed to analyze the precipitating events that cause AD in patients with cirrhosis. Proven bacterial infections and severe alcoholic hepatitis, either alone or in combination, accounted for almost all (96-97%) cases of AD and acute-on-chronic liver failure. Whilst the type of precipitant was not associated with mortality, the number of precipitant(s) was. This study identified precipitants that are significantly associated with a distinct clinical course and prognosis of patients with AD. Specific preventive and therapeutic strategies targeting these events may improve patient outcomes.