Liver Dysfunction and Systemic Inflammation Drive Organ Failures in Acute Decompensation of Cirrhosis: A Multicentric Study
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View abstract on PubMed
Summary
This summary is machine-generated.Approximately one-third of hospitalized cirrhosis patients rapidly progress to acute-on-chronic liver failure (ACLF), a condition with high mortality. Early identification of at-risk patients is crucial for timely interventions to prevent ACLF progression.
Area Of Science
- Hepatology
- Internal Medicine
- Clinical Research
Background
- Hospitalized patients with acute decompensation (AD) of cirrhosis face a high risk of progressing to acute-on-chronic liver failure (ACLF).
- ACLF significantly increases mortality rates in patients with cirrhosis.
- Identifying predictors of ACLF is crucial for managing AD patients.
Purpose Of The Study
- To identify key predictors and patient trajectories predisposing to ACLF in hospitalized AD patients.
- To develop and validate a predictive model for ACLF progression.
- To compare the performance of the new model against established scores like MELD 3.0.
Main Methods
- A multicenter, prospective study involving 625 patients with AD across India over 2 years.
- Data collected included clinical, biochemical, and 90-day survival information.
- Patients were divided into derivation and validation cohorts; predictive models were developed and compared with MELD 3.0 and CLIF-ACD scores.
Main Results
- 32.2% of AD patients progressed to ACLF, with significantly higher bilirubin, leukocyte counts, INR, and MELD 3.0, and lower sodium and survival rates compared to non-progressors.
- Liver failure at presentation and 7-day trajectories of bilirubin, INR, and MELD 3.0 were significant predictors of ACLF progression.
- A novel pre-ACLF model demonstrated superior predictive capability (AUC 0.71 in DC, 0.82 in VC) compared to existing scores.
Conclusions
- A significant proportion of AD patients in the Indian cohort rapidly progressed to ACLF, associated with high mortality.
- Early identification of patients at risk for ACLF is essential.
- Targeted interventions guided by early risk assessment can help prevent ACLF progression.
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