RT Journal Article
T1 The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology.
A1 Trebicka, Jonel
A1 Fernandez, Javier
A1 Papp, Maria
A1 Caraceni, Paolo
A1 Laleman, Wim
A1 Gambino, Carmine
A1 Giovo, Ilaria
A1 Uschner, Frank Erhard
A1 Jimenez, Cesar
A1 Mookerjee, Rajeshwar
A1 Gustot, Thierry
A1 Albillos, Agustin
A1 Bañares, Rafael
A1 Janicko, Martin
A1 Steib, Christian
A1 Reiberger, Thomas
A1 Acevedo, Juan
A1 Gatti, Pietro
A1 Bernal, William
A1 Zeuzem, Stefan
A1 Zipprich, Alexander
A1 Piano, Salvatore
A1 Berg, Thomas
A1 Bruns, Tony
A1 Bendtsen, Flemming
A1 Coenraad, Minneke
A1 Merli, Manuela
A1 Stauber, Rudolf
A1 Zoller, Heinz
A1 Ramos, José Presa
A1 Solè, Cristina
A1 Soriano, Germán
A1 de Gottardi, Andrea
A1 Gronbaek, Henning
A1 Saliba, Faouzi
A1 Trautwein, Christian
A1 Özdogan, Osman Cavit
A1 Francque, Sven
A1 Ryder, Stephen
A1 Nahon, Pierre
A1 Romero-Gomez, Manuel
A1 Van Vlierberghe, Hans
A1 Francoz, Claire
A1 Manns, Michael
A1 Garcia, Elisabet
A1 Tufoni, Manuel
A1 Amoros, Alex
A1 Pavesi, Marco
A1 Sanchez, Cristina
A1 Curto, Anna
A1 Pitarch, Carla
A1 Putignano, Antonella
A1 Moreno, Esau
A1 Shawcross, Debbie
A1 Aguilar, Ferran
A1 Clària, Joan
A1 Ponzo, Paola
A1 Jansen, Christian
A1 Vitalis, Zsuzsanna
A1 Zaccherini, Giacomo
A1 Balogh, Boglarka
A1 Vargas, Victor
A1 Montagnese, Sara
A1 Alessandria, Carlo
A1 Bernardi, Mauro
A1 Ginès, Pere
A1 Jalan, Rajiv
A1 Moreau, Richard
A1 Angeli, Paolo
A1 Arroyo, Vicente
A1 PREDICT STUDY group of the EASL-CLIF Consortium, 
K1 Acute complications
K1 Chronic liver disease
K1 Non-elective admission
K1 Outcome
K1 Risk factors
AB 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. 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. 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). 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. NCT03056612. 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.
YR 2020
FD 2020-07-13
LK http://hdl.handle.net/10668/15944
UL http://hdl.handle.net/10668/15944
LA en
DS RISalud
RD Apr 19, 2025