The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology

Trebicka, Jonel; Fernández, Javier; Papp, Maria; Caraceni, Paolo; Laleman, Wim; Gambino, Carmine; Giovo, Ilaria; Uschner, Frank Erhard; Jiménez, César; Mookerjee, Rajeshwar P.; Gustot, Thierry; Albillos, Agustín; Bañares, Rafael; Janicko, Martin; Steib, Christian; Reiberger, Thomas; Acevedo, Juan; Gatti, Pietro; Bernal, William; Zeuzem, Stefan; Zipprich, Alexander; Piano, Salvatore; Berg, Thomas; Bruns, Tony; Bendtsen, Flemming; Coenraad, Minneke J.; Merli, Manuela; Stauber, Rudolf E.; Zoller, Heinz; Presa Ramos, José; Solé Padullés, Cristina; Soriano Pastor, Germán; de Gottardi, Andrea; Gronbaek, Henning; Saliba, Faouzi; Trautwein, Christian; Özdogan, Osman Cavit; Francque, Sven; Ryder, Stephen; Nahon, Pierre; Romero-Gomez, Manuel; Vlierberghe, Hans Van; Francoz, Claire; Manns, Michael; Garcia, Elisabet; Tufoni, Manuel; Amorós, Àlex; Pavesi, Marco; Sanchez, Cristina; Curto, Anna; Pitarch, Carla; Putignano, Antonella; Moreno, Esau; Shawcross, Debbie; Aguilar, Ferran; Clària i Enrich, Joan; Ponzo, Paola; Jansen, Christian; Vitalis, Zsuzsanna; Zaccherini, Giacomo; Balogh, Boglarka; Vargas, Víctor; Montagnese, Sara; Alessandria, Carlo; Bernardi, Mauro; Ginès i Gibert, Pere; Jalan, Rajiv; Moreau, Richard; Angeli, Paolo; Arroyo, Vicente

The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology

Background & aims: 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-o...

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Autores:	Trebicka, Jonel, Fernández, Javier, Papp, Maria, Caraceni, Paolo, Laleman, Wim, Gambino, Carmine, Giovo, Ilaria, Uschner, Frank Erhard, Jiménez, César, Mookerjee, Rajeshwar P., Gustot, Thierry, Albillos, Agustín, Bañares, Rafael, Janicko, Martin, Steib, Christian, Reiberger, Thomas, Acevedo, Juan, Gatti, Pietro, Bernal, William, Zeuzem, Stefan, Zipprich, Alexander, Piano, Salvatore, Berg, Thomas, Bruns, Tony, Bendtsen, Flemming, Coenraad, Minneke J., Merli, Manuela, Stauber, Rudolf E., Zoller, Heinz, Presa Ramos, José, Solé Padullés, Cristina, Soriano Pastor, Germán, de Gottardi, Andrea, Gronbaek, Henning, Saliba, Faouzi, Trautwein, Christian, Özdogan, Osman Cavit, Francque, Sven, Ryder, Stephen, Nahon, Pierre, Romero-Gomez, Manuel, Vlierberghe, Hans Van, Francoz, Claire, Manns, Michael, Garcia, Elisabet, Tufoni, Manuel, Amorós, Àlex, Pavesi, Marco, Sanchez, Cristina, Curto, Anna, Pitarch, Carla, Putignano, Antonella, Moreno, Esau, Shawcross, Debbie, Aguilar, Ferran, Clària i Enrich, Joan, Ponzo, Paola, Jansen, Christian, Vitalis, Zsuzsanna, Zaccherini, Giacomo, Balogh, Boglarka, Vargas, Víctor, Montagnese, Sara, Alessandria, Carlo, Bernardi, Mauro, Ginès i Gibert, Pere, Jalan, Rajiv, Moreau, Richard, Angeli, Paolo, Arroyo, Vicente
Tipo de recurso:	artículo
Estado:	Versión aceptada para publicación
Fecha de publicación:	2020
País:	España
Institución:	Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:	Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:	oai:recercat.cat:2445/174861
Acceso en línea:	https://hdl.handle.net/2445/174861
Access Level:	acceso abierto
Palabra clave:	Cirrosi hepàtica Hemorràgia gastrointestinal Trasplantament hepàtic Hepatic cirrhosis Gastrointestinal hemorrhage Hepatic transplantation

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network_acronym_str	ES
network_name_str	España
repository_id_str
dc.title.none.fl_str_mv	The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology
title	The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology
spellingShingle	The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology Trebicka, Jonel Cirrosi hepàtica Hemorràgia gastrointestinal Trasplantament hepàtic Hepatic cirrhosis Gastrointestinal hemorrhage Hepatic transplantation
title_short	The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology
title_full	The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology
title_fullStr	The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology
title_full_unstemmed	The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology
title_sort	The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology
dc.creator.none.fl_str_mv	Trebicka, Jonel Fernández, Javier Papp, Maria Caraceni, Paolo Laleman, Wim Gambino, Carmine Giovo, Ilaria Uschner, Frank Erhard Jiménez, César Mookerjee, Rajeshwar P. Gustot, Thierry Albillos, Agustín Bañares, Rafael Janicko, Martin Steib, Christian Reiberger, Thomas Acevedo, Juan Gatti, Pietro Bernal, William Zeuzem, Stefan Zipprich, Alexander Piano, Salvatore Berg, Thomas Bruns, Tony Bendtsen, Flemming Coenraad, Minneke J. Merli, Manuela Stauber, Rudolf E. Zoller, Heinz Presa Ramos, José Solé Padullés, Cristina Soriano Pastor, Germán de Gottardi, Andrea Gronbaek, Henning Saliba, Faouzi Trautwein, Christian Özdogan, Osman Cavit Francque, Sven Ryder, Stephen Nahon, Pierre Romero-Gomez, Manuel Vlierberghe, Hans Van Francoz, Claire Manns, Michael Garcia, Elisabet Tufoni, Manuel Amorós, Àlex Pavesi, Marco Sanchez, Cristina Curto, Anna Pitarch, Carla Putignano, Antonella Moreno, Esau Shawcross, Debbie Aguilar, Ferran Clària i Enrich, Joan Ponzo, Paola Jansen, Christian Vitalis, Zsuzsanna Zaccherini, Giacomo Balogh, Boglarka Vargas, Víctor Montagnese, Sara Alessandria, Carlo Bernardi, Mauro Ginès i Gibert, Pere Jalan, Rajiv Moreau, Richard Angeli, Paolo Arroyo, Vicente
author	Trebicka, Jonel
author_facet	Trebicka, Jonel Fernández, Javier Papp, Maria Caraceni, Paolo Laleman, Wim Gambino, Carmine Giovo, Ilaria Uschner, Frank Erhard Jiménez, César Mookerjee, Rajeshwar P. Gustot, Thierry Albillos, Agustín Bañares, Rafael Janicko, Martin Steib, Christian Reiberger, Thomas Acevedo, Juan Gatti, Pietro Bernal, William Zeuzem, Stefan Zipprich, Alexander Piano, Salvatore Berg, Thomas Bruns, Tony Bendtsen, Flemming Coenraad, Minneke J. Merli, Manuela Stauber, Rudolf E. Zoller, Heinz Presa Ramos, José Solé Padullés, Cristina Soriano Pastor, Germán de Gottardi, Andrea Gronbaek, Henning Saliba, Faouzi Trautwein, Christian Özdogan, Osman Cavit Francque, Sven Ryder, Stephen Nahon, Pierre Romero-Gomez, Manuel Vlierberghe, Hans Van Francoz, Claire Manns, Michael Garcia, Elisabet Tufoni, Manuel Amorós, Àlex Pavesi, Marco Sanchez, Cristina Curto, Anna Pitarch, Carla Putignano, Antonella Moreno, Esau Shawcross, Debbie Aguilar, Ferran Clària i Enrich, Joan Ponzo, Paola Jansen, Christian Vitalis, Zsuzsanna Zaccherini, Giacomo Balogh, Boglarka Vargas, Víctor Montagnese, Sara Alessandria, Carlo Bernardi, Mauro Ginès i Gibert, Pere Jalan, Rajiv Moreau, Richard Angeli, Paolo Arroyo, Vicente
author_role	author
author2	Fernández, Javier Papp, Maria Caraceni, Paolo Laleman, Wim Gambino, Carmine Giovo, Ilaria Uschner, Frank Erhard Jiménez, César Mookerjee, Rajeshwar P. Gustot, Thierry Albillos, Agustín Bañares, Rafael Janicko, Martin Steib, Christian Reiberger, Thomas Acevedo, Juan Gatti, Pietro Bernal, William Zeuzem, Stefan Zipprich, Alexander Piano, Salvatore Berg, Thomas Bruns, Tony Bendtsen, Flemming Coenraad, Minneke J. Merli, Manuela Stauber, Rudolf E. Zoller, Heinz Presa Ramos, José Solé Padullés, Cristina Soriano Pastor, Germán de Gottardi, Andrea Gronbaek, Henning Saliba, Faouzi Trautwein, Christian Özdogan, Osman Cavit Francque, Sven Ryder, Stephen Nahon, Pierre Romero-Gomez, Manuel Vlierberghe, Hans Van Francoz, Claire Manns, Michael Garcia, Elisabet Tufoni, Manuel Amorós, Àlex Pavesi, Marco Sanchez, Cristina Curto, Anna Pitarch, Carla Putignano, Antonella Moreno, Esau Shawcross, Debbie Aguilar, Ferran Clària i Enrich, Joan Ponzo, Paola Jansen, Christian Vitalis, Zsuzsanna Zaccherini, Giacomo Balogh, Boglarka Vargas, Víctor Montagnese, Sara Alessandria, Carlo Bernardi, Mauro Ginès i Gibert, Pere Jalan, Rajiv Moreau, Richard Angeli, Paolo Arroyo, Vicente
author2_role	author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author
dc.subject.none.fl_str_mv	Cirrosi hepàtica Hemorràgia gastrointestinal Trasplantament hepàtic Hepatic cirrhosis Gastrointestinal hemorrhage Hepatic transplantation
topic	Cirrosi hepàtica Hemorràgia gastrointestinal Trasplantament hepàtic Hepatic cirrhosis Gastrointestinal hemorrhage Hepatic transplantation
description	Background & aims: 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. Methods: 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. Results: 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). Conclusions: 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. 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.
publishDate	2020
dc.date.none.fl_str_mv	2020 2021 2021 2021
dc.type.none.fl_str_mv	info:eu-repo/semantics/article info:eu-repo/semantics/acceptedVersion info:eu-repo/semantics/publishedVersion
format	article
status_str	acceptedVersion
dc.identifier.none.fl_str_mv	https://hdl.handle.net/2445/174861
url	https://hdl.handle.net/2445/174861
dc.language.none.fl_str_mv	Inglés
language_invalid_str_mv	Inglés
dc.relation.none.fl_str_mv	Reproducció del document publicat a: https://doi.org/10.1016/j.jhep.2020.06.013 Journal of Hepatology, 2020, vol. 73, num. 4, p. 842-854 https://doi.org/10.1016/j.jhep.2020.06.013
dc.rights.none.fl_str_mv	cc-by-nc-nd (c) Trebicka et. al., 2020 http://creativecommons.org/licenses/by-nc-nd/3.0/es info:eu-repo/semantics/openAccess
rights_invalid_str_mv	cc-by-nc-nd (c) Trebicka et. al., 2020 http://creativecommons.org/licenses/by-nc-nd/3.0/es
eu_rights_str_mv	openAccess
dc.format.none.fl_str_mv	13 p. application/pdf
dc.publisher.none.fl_str_mv	Elsevier
publisher.none.fl_str_mv	Elsevier
dc.source.none.fl_str_mv	Articles publicats en revistes (Medicina) reponame:Recercat. Dipósit de la Recerca de Catalunya instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str	Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str	Recercat. Dipósit de la Recerca de Catalunya
collection	Recercat. Dipósit de la Recerca de Catalunya
repository.name.fl_str_mv
repository.mail.fl_str_mv
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spelling	The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiologyTrebicka, JonelFernández, JavierPapp, MariaCaraceni, PaoloLaleman, WimGambino, CarmineGiovo, IlariaUschner, Frank ErhardJiménez, CésarMookerjee, Rajeshwar P.Gustot, ThierryAlbillos, AgustínBañares, RafaelJanicko, MartinSteib, ChristianReiberger, ThomasAcevedo, JuanGatti, PietroBernal, WilliamZeuzem, StefanZipprich, AlexanderPiano, SalvatoreBerg, ThomasBruns, TonyBendtsen, FlemmingCoenraad, Minneke J.Merli, ManuelaStauber, Rudolf E.Zoller, HeinzPresa Ramos, JoséSolé Padullés, CristinaSoriano Pastor, Germánde Gottardi, AndreaGronbaek, HenningSaliba, FaouziTrautwein, ChristianÖzdogan, Osman CavitFrancque, SvenRyder, StephenNahon, PierreRomero-Gomez, ManuelVlierberghe, Hans VanFrancoz, ClaireManns, MichaelGarcia, ElisabetTufoni, ManuelAmorós, ÀlexPavesi, MarcoSanchez, CristinaCurto, AnnaPitarch, CarlaPutignano, AntonellaMoreno, EsauShawcross, DebbieAguilar, FerranClària i Enrich, JoanPonzo, PaolaJansen, ChristianVitalis, ZsuzsannaZaccherini, GiacomoBalogh, BoglarkaVargas, VíctorMontagnese, SaraAlessandria, CarloBernardi, MauroGinès i Gibert, PereJalan, RajivMoreau, RichardAngeli, PaoloArroyo, VicenteCirrosi hepàticaHemorràgia gastrointestinalTrasplantament hepàticHepatic cirrhosisGastrointestinal hemorrhageHepatic transplantationBackground & aims: 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. Methods: 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. Results: 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). Conclusions: 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. 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.Elsevier2021202120202021info:eu-repo/semantics/articleinfo:eu-repo/semantics/acceptedVersioninfo:eu-repo/semantics/publishedVersion13 p.application/pdfhttps://hdl.handle.net/2445/174861Articles publicats en revistes (Medicina)reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésReproducció del document publicat a: https://doi.org/10.1016/j.jhep.2020.06.013Journal of Hepatology, 2020, vol. 73, num. 4, p. 842-854https://doi.org/10.1016/j.jhep.2020.06.013cc-by-nc-nd (c) Trebicka et. al., 2020http://creativecommons.org/licenses/by-nc-nd/3.0/esinfo:eu-repo/semantics/openAccessoai:recercat.cat:2445/1748612026-05-29T05:05:01Z
score	15,81155

The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology

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