Vulnerability to recurrent episodes of acute decompensation/acute-on-chronic liver failure characterizes those triggered by indeterminate precipitants in patients with liver cirrhosis.
<h4>Background</h4>Acute decompensation (AD) of liver cirrhosis (LC) and subsequent acute-on-chronic liver failure (ACLF) are fatal and impair quality of life. Insufficient knowledge of the highly heterogeneous natural history of LC, including decompensation, re-compensation, and possibl...
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2021-01-01
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| author | Hitomi Hoshi Po-Sung Chu Aya Yoshida Nobuhito Taniki Rei Morikawa Karin Yamataka Fumie Noguchi Ryosuke Kasuga Takaya Tabuchi Hirotoshi Ebinuma Hidetsugu Saito Takanori Kanai Nobuhiro Nakamoto |
| author_facet | Hitomi Hoshi Po-Sung Chu Aya Yoshida Nobuhito Taniki Rei Morikawa Karin Yamataka Fumie Noguchi Ryosuke Kasuga Takaya Tabuchi Hirotoshi Ebinuma Hidetsugu Saito Takanori Kanai Nobuhiro Nakamoto |
| author_sort | Hitomi Hoshi |
| collection | DOAJ |
| description | <h4>Background</h4>Acute decompensation (AD) of liver cirrhosis (LC) and subsequent acute-on-chronic liver failure (ACLF) are fatal and impair quality of life. Insufficient knowledge of the highly heterogeneous natural history of LC, including decompensation, re-compensation, and possible recurrent decompensation, hinders the development and application of novel therapeutics. Approximately 10%-50% of AD/ACLF is reported to be precipitated by any indeterminate (unidentifiable, cryptogenic, or unknown) acute insults; however, its clinical characteristics are unclear.<h4>Methods</h4>We conducted a single-center observational study of 2165 consecutively admitted patients with LC from January 2012 to December 2019. A total of 466 episodes of AD/ACLF in 285 patients, including their 285 first indexed AD/ACLF, were extracted for analysis. Stratified analyses of different acute precipitants, classified as indeterminate (AD/ACLFIND), bacterial infection (AD/ACLFBAC), gastrointestinal bleeding, active alcoholism, and miscellaneous, were performed.<h4>Results</h4>AD/ACLFIND was the leading acute precipitant (28%), followed by AD/ACLFBAC (23%). AD/ACLFIND showed better survival outcomes than AD/ACLFBAC (P = 0.03); however, hyperbilirubinemia, hyponatremia, or leukocytosis significantly and uniquely characterized subgroups of AD/ACLFIND with comparable or even worse survival outcomes than those of AD/ACLFBAC. Patients with subsequent AD/ACLF significantly tended to suffer from AD/ACLF with any organ failure in AD/ACLFIND but not in AD/ACLFBAC (P = 0.004, for trend). In competing risk analysis, patients with AD/ACLFIND were significantly more vulnerable to suffer from recurrent episodes of AD/ACLF within 180 days, compared to those triggered by other precipitants (P = 0.04).<h4>Conclusions</h4>AD/ACLFIND, the leading acute precipitant, also plays a role in subsequent AD/ACLF. An abruptly exacerbating, remitting, and relapsing nature of systemic inflammation underlying AD/ACLF may also be useful for risk estimation. |
| format | Article |
| id | doaj-art-2b60a05549f641af948301a009dc191b |
| institution | OA Journals |
| issn | 1932-6203 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Public Library of Science (PLoS) |
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| spelling | doaj-art-2b60a05549f641af948301a009dc191b2025-08-20T02:17:54ZengPublic Library of Science (PLoS)PLoS ONE1932-62032021-01-01164e025006210.1371/journal.pone.0250062Vulnerability to recurrent episodes of acute decompensation/acute-on-chronic liver failure characterizes those triggered by indeterminate precipitants in patients with liver cirrhosis.Hitomi HoshiPo-Sung ChuAya YoshidaNobuhito TanikiRei MorikawaKarin YamatakaFumie NoguchiRyosuke KasugaTakaya TabuchiHirotoshi EbinumaHidetsugu SaitoTakanori KanaiNobuhiro Nakamoto<h4>Background</h4>Acute decompensation (AD) of liver cirrhosis (LC) and subsequent acute-on-chronic liver failure (ACLF) are fatal and impair quality of life. Insufficient knowledge of the highly heterogeneous natural history of LC, including decompensation, re-compensation, and possible recurrent decompensation, hinders the development and application of novel therapeutics. Approximately 10%-50% of AD/ACLF is reported to be precipitated by any indeterminate (unidentifiable, cryptogenic, or unknown) acute insults; however, its clinical characteristics are unclear.<h4>Methods</h4>We conducted a single-center observational study of 2165 consecutively admitted patients with LC from January 2012 to December 2019. A total of 466 episodes of AD/ACLF in 285 patients, including their 285 first indexed AD/ACLF, were extracted for analysis. Stratified analyses of different acute precipitants, classified as indeterminate (AD/ACLFIND), bacterial infection (AD/ACLFBAC), gastrointestinal bleeding, active alcoholism, and miscellaneous, were performed.<h4>Results</h4>AD/ACLFIND was the leading acute precipitant (28%), followed by AD/ACLFBAC (23%). AD/ACLFIND showed better survival outcomes than AD/ACLFBAC (P = 0.03); however, hyperbilirubinemia, hyponatremia, or leukocytosis significantly and uniquely characterized subgroups of AD/ACLFIND with comparable or even worse survival outcomes than those of AD/ACLFBAC. Patients with subsequent AD/ACLF significantly tended to suffer from AD/ACLF with any organ failure in AD/ACLFIND but not in AD/ACLFBAC (P = 0.004, for trend). In competing risk analysis, patients with AD/ACLFIND were significantly more vulnerable to suffer from recurrent episodes of AD/ACLF within 180 days, compared to those triggered by other precipitants (P = 0.04).<h4>Conclusions</h4>AD/ACLFIND, the leading acute precipitant, also plays a role in subsequent AD/ACLF. An abruptly exacerbating, remitting, and relapsing nature of systemic inflammation underlying AD/ACLF may also be useful for risk estimation.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0250062&type=printable |
| spellingShingle | Hitomi Hoshi Po-Sung Chu Aya Yoshida Nobuhito Taniki Rei Morikawa Karin Yamataka Fumie Noguchi Ryosuke Kasuga Takaya Tabuchi Hirotoshi Ebinuma Hidetsugu Saito Takanori Kanai Nobuhiro Nakamoto Vulnerability to recurrent episodes of acute decompensation/acute-on-chronic liver failure characterizes those triggered by indeterminate precipitants in patients with liver cirrhosis. PLoS ONE |
| title | Vulnerability to recurrent episodes of acute decompensation/acute-on-chronic liver failure characterizes those triggered by indeterminate precipitants in patients with liver cirrhosis. |
| title_full | Vulnerability to recurrent episodes of acute decompensation/acute-on-chronic liver failure characterizes those triggered by indeterminate precipitants in patients with liver cirrhosis. |
| title_fullStr | Vulnerability to recurrent episodes of acute decompensation/acute-on-chronic liver failure characterizes those triggered by indeterminate precipitants in patients with liver cirrhosis. |
| title_full_unstemmed | Vulnerability to recurrent episodes of acute decompensation/acute-on-chronic liver failure characterizes those triggered by indeterminate precipitants in patients with liver cirrhosis. |
| title_short | Vulnerability to recurrent episodes of acute decompensation/acute-on-chronic liver failure characterizes those triggered by indeterminate precipitants in patients with liver cirrhosis. |
| title_sort | vulnerability to recurrent episodes of acute decompensation acute on chronic liver failure characterizes those triggered by indeterminate precipitants in patients with liver cirrhosis |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0250062&type=printable |
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