Acute-on-chronic liver failure in cirrhosis

The definition of acute-on-chronic liver failure (ACLF) remains contested. In Europe and North America, the term is generally applied according to the European Association for the Study of the Liver-Chronic Liver Failure (EASL-CLIF) Consortium guidelines, which defines this condition as a syndrome t...

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Autores: Arroyo, Vicente, Moreau, Richard, Kamath, Patrick S., Jalan, Rajiv, Ginès i Gibert, Pere, Nevens, Frederick, Fernández, Javier, To, Uyen, Garcia-Tsao, Guadalupe, Schnabl, Bernd
Tipo de recurso: artículo
Estado:Versión aceptada para publicación
Fecha de publicación:2016
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/128720
Acceso en línea:https://hdl.handle.net/2445/128720
Access Level:acceso abierto
Palabra clave:Cirrosi hepàtica
Malalties del fetge
Complicacions (Medicina)
Hepatic cirrhosis
Liver diseases
Complications (Medicine)
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spelling Acute-on-chronic liver failure in cirrhosisArroyo, VicenteMoreau, RichardKamath, Patrick S.Jalan, RajivGinès i Gibert, PereNevens, FrederickFernández, JavierTo, UyenGarcia-Tsao, GuadalupeSchnabl, BerndCirrosi hepàticaMalalties del fetgeComplicacions (Medicina)Hepatic cirrhosisLiver diseasesComplications (Medicine)The definition of acute-on-chronic liver failure (ACLF) remains contested. In Europe and North America, the term is generally applied according to the European Association for the Study of the Liver-Chronic Liver Failure (EASL-CLIF) Consortium guidelines, which defines this condition as a syndrome that develops in patients with cirrhosis and is characterized by acute decompensation, organ failure and high short-term mortality. One-third of patients who are hospitalized for acute decompensation present with ACLF at admission or develop the syndrome during hospitalization. ACLF frequently occurs in a closed temporal relationship to a precipitating event, such as bacterial infection or acute alcoholic, drug-induced or viral hepatitis. However, no precipitating event can be identified in approximately 40% of patients. The mechanisms of ACLF involve systemic inflammation due to infections, acute liver damage and, in cases without precipitating events, probably intestinal translocation of bacteria or bacterial products. ACLF is graded into three stages (ACLF grades 1-3) on the basis of the number of organ failures, with higher grades associated with increased mortality. Liver and renal failures are the most common organ failures, followed by coagulation, brain, circulatory and respiratory failure. The 28-day mortality rate associated with ACLF is 30%. Depending on the grade, ACLF can be reversed using standard therapy in only 16-51% of patients, leaving a considerable proportion of patients with ACLF that remains steady or progresses. Liver transplantation in selected patients with ACLF grade 2 and ACLF grade 3 increases the 6-month survival from 10% to 80%.Nature Publishing Group2016info:eu-repo/semantics/articleinfo:eu-repo/semantics/acceptedVersionapplication/pdfhttps://hdl.handle.net/2445/128720Articles publicats en revistes (Medicina)reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésVersió postprint del document publicat a: https://doi.org/10.1038/nrdp.2016.41Nature Reviews Disease Primers, 2016, vol. 2, num. 16041https://doi.org/10.1038/nrdp.2016.41(c) Arroyo, Vicente et al., 2016info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/1287202026-05-27T06:46:51Z
dc.title.none.fl_str_mv Acute-on-chronic liver failure in cirrhosis
title Acute-on-chronic liver failure in cirrhosis
spellingShingle Acute-on-chronic liver failure in cirrhosis
Arroyo, Vicente
Cirrosi hepàtica
Malalties del fetge
Complicacions (Medicina)
Hepatic cirrhosis
Liver diseases
Complications (Medicine)
title_short Acute-on-chronic liver failure in cirrhosis
title_full Acute-on-chronic liver failure in cirrhosis
title_fullStr Acute-on-chronic liver failure in cirrhosis
title_full_unstemmed Acute-on-chronic liver failure in cirrhosis
title_sort Acute-on-chronic liver failure in cirrhosis
dc.creator.none.fl_str_mv Arroyo, Vicente
Moreau, Richard
Kamath, Patrick S.
Jalan, Rajiv
Ginès i Gibert, Pere
Nevens, Frederick
Fernández, Javier
To, Uyen
Garcia-Tsao, Guadalupe
Schnabl, Bernd
author Arroyo, Vicente
author_facet Arroyo, Vicente
Moreau, Richard
Kamath, Patrick S.
Jalan, Rajiv
Ginès i Gibert, Pere
Nevens, Frederick
Fernández, Javier
To, Uyen
Garcia-Tsao, Guadalupe
Schnabl, Bernd
author_role author
author2 Moreau, Richard
Kamath, Patrick S.
Jalan, Rajiv
Ginès i Gibert, Pere
Nevens, Frederick
Fernández, Javier
To, Uyen
Garcia-Tsao, Guadalupe
Schnabl, Bernd
author2_role author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Cirrosi hepàtica
Malalties del fetge
Complicacions (Medicina)
Hepatic cirrhosis
Liver diseases
Complications (Medicine)
topic Cirrosi hepàtica
Malalties del fetge
Complicacions (Medicina)
Hepatic cirrhosis
Liver diseases
Complications (Medicine)
description The definition of acute-on-chronic liver failure (ACLF) remains contested. In Europe and North America, the term is generally applied according to the European Association for the Study of the Liver-Chronic Liver Failure (EASL-CLIF) Consortium guidelines, which defines this condition as a syndrome that develops in patients with cirrhosis and is characterized by acute decompensation, organ failure and high short-term mortality. One-third of patients who are hospitalized for acute decompensation present with ACLF at admission or develop the syndrome during hospitalization. ACLF frequently occurs in a closed temporal relationship to a precipitating event, such as bacterial infection or acute alcoholic, drug-induced or viral hepatitis. However, no precipitating event can be identified in approximately 40% of patients. The mechanisms of ACLF involve systemic inflammation due to infections, acute liver damage and, in cases without precipitating events, probably intestinal translocation of bacteria or bacterial products. ACLF is graded into three stages (ACLF grades 1-3) on the basis of the number of organ failures, with higher grades associated with increased mortality. Liver and renal failures are the most common organ failures, followed by coagulation, brain, circulatory and respiratory failure. The 28-day mortality rate associated with ACLF is 30%. Depending on the grade, ACLF can be reversed using standard therapy in only 16-51% of patients, leaving a considerable proportion of patients with ACLF that remains steady or progresses. Liver transplantation in selected patients with ACLF grade 2 and ACLF grade 3 increases the 6-month survival from 10% to 80%.
publishDate 2016
dc.date.none.fl_str_mv 2016
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/acceptedVersion
format article
status_str acceptedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/128720
url https://hdl.handle.net/2445/128720
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Versió postprint del document publicat a: https://doi.org/10.1038/nrdp.2016.41
Nature Reviews Disease Primers, 2016, vol. 2, num. 16041
https://doi.org/10.1038/nrdp.2016.41
dc.rights.none.fl_str_mv (c) Arroyo, Vicente et al., 2016
info:eu-repo/semantics/openAccess
rights_invalid_str_mv (c) Arroyo, Vicente et al., 2016
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Nature Publishing Group
publisher.none.fl_str_mv Nature Publishing Group
dc.source.none.fl_str_mv Articles publicats en revistes (Medicina)
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
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