RT Journal Article
T1 PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis.
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 Jansen, Christian
A1 Jimenez, Cesar
A1 Mookerjee, Rajeshwar
A1 Gustot, Thierry
A1 Albillos, Agustin
A1 Bañares, Rafael
A1 Jarcuska, Peter
A1 Steib, Christian
A1 Reiberger, Thomas
A1 Acevedo, Juan
A1 Gatti, Pietro
A1 Shawcross, Debbie L
A1 Zeuzem, Stefan
A1 Zipprich, Alexander
A1 Piano, Salvatore
A1 Berg, Thomas
A1 Bruns, Tony
A1 Danielsen, Karen Vagner
A1 Coenraad, Minneke
A1 Merli, Manuela
A1 Stauber, Rudolf
A1 Zoller, Heinz
A1 Ramos, José Presa
A1 Solé, Cristina
A1 Soriano, Germán
A1 de Gottardi, Andrea
A1 Gronbaek, Henning
A1 Saliba, Faouzi
A1 Trautwein, Christian
A1 Kani, Haluk Tarik
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-Lopez, Elisabet
A1 Tufoni, Manuel
A1 Amoros, Alex
A1 Pavesi, Marco
A1 Sanchez, Cristina
A1 Praktiknjo, Michael
A1 Curto, Anna
A1 Pitarch, Carla
A1 Putignano, Antonella
A1 Moreno, Esau
A1 Bernal, William
A1 Aguilar, Ferran
A1 Clària, Joan
A1 Ponzo, Paola
A1 Vitalis, Zsuzsanna
A1 Zaccherini, Giacomo
A1 Balogh, Boglarka
A1 Gerbes, Alexander
A1 Vargas, Victor
A1 Alessandria, Carlo
A1 Bernardi, Mauro
A1 Ginès, Pere
A1 Moreau, Richard
A1 Angeli, Paolo
A1 Jalan, Rajiv
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 may present without acute-on-chronic liver failure (ACLF) (AD-No ACLF), or with ACLF (AD-ACLF), defined by organ failure(s). Herein, we aimed to analyze and characterize the precipitants leading to both of these AD phenotypes. 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. 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. 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. 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.
YR 2020
FD 2020-11-20
LK http://hdl.handle.net/10668/16653
UL http://hdl.handle.net/10668/16653
LA en
DS RISalud
RD Apr 11, 2025