PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis
BACKGROUND & AIMS: 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. METHODS: Th...
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| Veröffentlicht in: | JOURNAL OF HEPATOLOGY 2021-05, Vol.74 (5), p.1097-1108 |
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| creator | Trebicka, Jonel Fernandez, Javier Papp, Maria Caraceni, Paolo Laleman, Wim Gambino, Carmine Giovo, Ilaria Uschner, Frank Erhard Jansen, Christian Jimenez, Cesar Mookerjee, Rajeshwar Gustot, Thierry Albillos, Agustin Banares, Rafael Jarcuska, Peter Steib, Christian Reiberger, Thomas Acevedo, Juan Gatti, Pietro Shawcross, Debbie L Zeuzem, Stefan Zipprich, Alexander Piano, Salvatore Berg, Thomas Bruns, Tony Danielsen, Karen Vagner Coenraad, Minneke Merli, Manuela Stauber, Rudolf Zoller, Heinz Ramos, Jose Presa Sole, Cristina Soriano, German de Gottardi, Andrea Gronbaek, Henning Saliba, Faouzi Trautwein, Christian Kani, Haluk Tarik Francque, Sven Ryder, Stephen Nahon, Pierre Romero-Gomez, Manuel Van Vlierberghe, Hans Francoz, Claire Manns, Michael Garcia-Lopez, Elisabet Tufoni, Manuel Amoros, Alex Pavesi, Marco Sanchez, Cristina Praktiknjo, Michael Curto, Anna Pitarch, Carla Putignano, Antonella Moreno, Esau Bernal, William Aguilar, Ferran Claria, Joan Ponzo, Paola Vitalis, Zsuzsanna Zaccherini, Giacomo Balogh, Boglarka Gerbes, Alexander Vargas, Victor Alessandria, Carlo Bernardi, Mauro Gines, Pere Moreau, Richard Angeli, Paolo Jalan, Rajiv Arroyo, Vicente Maschmeier, Miriam Semela, David Elkrief, Laure Elsharkawy, Ahmed Tornai, Tamas Tornai, Istvan Altorjay, Istvan Antognoli, Agnese Baldassarre, Maurizio Gagliardi, Martina Bertoli, Eleonora Mareso, Sara Brocca, Alessandra Campion, Daniela Saracco, Giorgio Maria Rizzo, Martina Lehmann, Jennifer Pohlmann, Alessandra Brol, Maximilian J Chang, Johannes Schierwagen, Robert Sola, Elsa Amari, Nesrine Rodriguez, Miguel Nevens, Frederik Clemente, Ana Janicko, Martin Markwardt, Daniel Mandorfer, Mattias |
| description | BACKGROUND & AIMS: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. LAY SUMMARY: 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 precipita |
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| fullrecord | <record><control><sourceid>kuleuven</sourceid><recordid>TN_cdi_kuleuven_dspace_123456789_664400</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>123456789_664400</sourcerecordid><originalsourceid>FETCH-kuleuven_dspace_123456789_6644003</originalsourceid><addsrcrecordid>eNqVjrFuwkAQRK8gEiTwD9tRREgHNsbUQBQ6FNFbp_UaLxx3lncdyN_HivgAUk0x72lmYEZ2nuWzfLHKh-ZV5GytTew6HZlw-Npt95sjcElBuWISaFpCblidcjgBffeFgBOJyE6phBtrDVoToOfA6Dxg7FohiBU47JT8D5SE8dpQkD8DuW3rKCxj81I5LzR55JuZfuyOm8_ZpfPU9UtFKY1DKuaLJF1mq3xdZFma9m__Q74_RxZ61-QX5ctY1Q</addsrcrecordid><sourcetype>Institutional Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis</title><source>Lirias (KU Leuven Association)</source><source>Elsevier ScienceDirect Journals Collection</source><creator>Trebicka, Jonel ; Fernandez, Javier ; Papp, Maria ; Caraceni, Paolo ; Laleman, Wim ; Gambino, Carmine ; Giovo, Ilaria ; Uschner, Frank Erhard ; Jansen, Christian ; Jimenez, Cesar ; Mookerjee, Rajeshwar ; Gustot, Thierry ; Albillos, Agustin ; Banares, Rafael ; Jarcuska, Peter ; Steib, Christian ; Reiberger, Thomas ; Acevedo, Juan ; Gatti, Pietro ; Shawcross, Debbie L ; Zeuzem, Stefan ; Zipprich, Alexander ; Piano, Salvatore ; Berg, Thomas ; Bruns, Tony ; Danielsen, Karen Vagner ; Coenraad, Minneke ; Merli, Manuela ; Stauber, Rudolf ; Zoller, Heinz ; Ramos, Jose Presa ; Sole, Cristina ; Soriano, German ; de Gottardi, Andrea ; Gronbaek, Henning ; Saliba, Faouzi ; Trautwein, Christian ; Kani, Haluk Tarik ; Francque, Sven ; Ryder, Stephen ; Nahon, Pierre ; Romero-Gomez, Manuel ; Van Vlierberghe, Hans ; Francoz, Claire ; Manns, Michael ; Garcia-Lopez, Elisabet ; Tufoni, Manuel ; Amoros, Alex ; Pavesi, Marco ; Sanchez, Cristina ; Praktiknjo, Michael ; Curto, Anna ; Pitarch, Carla ; Putignano, Antonella ; Moreno, Esau ; Bernal, William ; Aguilar, Ferran ; Claria, Joan ; Ponzo, Paola ; Vitalis, Zsuzsanna ; Zaccherini, Giacomo ; Balogh, Boglarka ; Gerbes, Alexander ; Vargas, Victor ; Alessandria, Carlo ; Bernardi, Mauro ; Gines, Pere ; Moreau, Richard ; Angeli, Paolo ; Jalan, Rajiv ; Arroyo, Vicente ; Maschmeier, Miriam ; Semela, David ; Elkrief, Laure ; Elsharkawy, Ahmed ; Tornai, Tamas ; Tornai, Istvan ; Altorjay, Istvan ; Antognoli, Agnese ; Baldassarre, Maurizio ; Gagliardi, Martina ; Bertoli, Eleonora ; Mareso, Sara ; Brocca, Alessandra ; Campion, Daniela ; Saracco, Giorgio Maria ; Rizzo, Martina ; Lehmann, Jennifer ; Pohlmann, Alessandra ; Brol, Maximilian J ; Chang, Johannes ; Schierwagen, Robert ; Sola, Elsa ; Amari, Nesrine ; Rodriguez, Miguel ; Nevens, Frederik ; Clemente, Ana ; Janicko, Martin ; Markwardt, Daniel ; Mandorfer, Mattias</creator><creatorcontrib>Trebicka, Jonel ; Fernandez, Javier ; Papp, Maria ; Caraceni, Paolo ; Laleman, Wim ; Gambino, Carmine ; Giovo, Ilaria ; Uschner, Frank Erhard ; Jansen, Christian ; Jimenez, Cesar ; Mookerjee, Rajeshwar ; Gustot, Thierry ; Albillos, Agustin ; Banares, Rafael ; Jarcuska, Peter ; Steib, Christian ; Reiberger, Thomas ; Acevedo, Juan ; Gatti, Pietro ; Shawcross, Debbie L ; Zeuzem, Stefan ; Zipprich, Alexander ; Piano, Salvatore ; Berg, Thomas ; Bruns, Tony ; Danielsen, Karen Vagner ; Coenraad, Minneke ; Merli, Manuela ; Stauber, Rudolf ; Zoller, Heinz ; Ramos, Jose Presa ; Sole, Cristina ; Soriano, German ; de Gottardi, Andrea ; Gronbaek, Henning ; Saliba, Faouzi ; Trautwein, Christian ; Kani, Haluk Tarik ; Francque, Sven ; Ryder, Stephen ; Nahon, Pierre ; Romero-Gomez, Manuel ; Van Vlierberghe, Hans ; Francoz, Claire ; Manns, Michael ; Garcia-Lopez, Elisabet ; Tufoni, Manuel ; Amoros, Alex ; Pavesi, Marco ; Sanchez, Cristina ; Praktiknjo, Michael ; Curto, Anna ; Pitarch, Carla ; Putignano, Antonella ; Moreno, Esau ; Bernal, William ; Aguilar, Ferran ; Claria, Joan ; Ponzo, Paola ; Vitalis, Zsuzsanna ; Zaccherini, Giacomo ; Balogh, Boglarka ; Gerbes, Alexander ; Vargas, Victor ; Alessandria, Carlo ; Bernardi, Mauro ; Gines, Pere ; Moreau, Richard ; Angeli, Paolo ; Jalan, Rajiv ; Arroyo, Vicente ; Maschmeier, Miriam ; Semela, David ; Elkrief, Laure ; Elsharkawy, Ahmed ; Tornai, Tamas ; Tornai, Istvan ; Altorjay, Istvan ; Antognoli, Agnese ; Baldassarre, Maurizio ; Gagliardi, Martina ; Bertoli, Eleonora ; Mareso, Sara ; Brocca, Alessandra ; Campion, Daniela ; Saracco, Giorgio Maria ; Rizzo, Martina ; Lehmann, Jennifer ; Pohlmann, Alessandra ; Brol, Maximilian J ; Chang, Johannes ; Schierwagen, Robert ; Sola, Elsa ; Amari, Nesrine ; Rodriguez, Miguel ; Nevens, Frederik ; Clemente, Ana ; Janicko, Martin ; Markwardt, Daniel ; Mandorfer, Mattias</creatorcontrib><description>BACKGROUND & AIMS: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. LAY SUMMARY: 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.</description><identifier>ISSN: 0168-8278</identifier><language>eng</language><publisher>ELSEVIER</publisher><ispartof>JOURNAL OF HEPATOLOGY, 2021-05, Vol.74 (5), p.1097-1108</ispartof><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,315,776,780,27837</link.rule.ids></links><search><creatorcontrib>Trebicka, Jonel</creatorcontrib><creatorcontrib>Fernandez, Javier</creatorcontrib><creatorcontrib>Papp, Maria</creatorcontrib><creatorcontrib>Caraceni, Paolo</creatorcontrib><creatorcontrib>Laleman, Wim</creatorcontrib><creatorcontrib>Gambino, Carmine</creatorcontrib><creatorcontrib>Giovo, Ilaria</creatorcontrib><creatorcontrib>Uschner, Frank Erhard</creatorcontrib><creatorcontrib>Jansen, Christian</creatorcontrib><creatorcontrib>Jimenez, Cesar</creatorcontrib><creatorcontrib>Mookerjee, Rajeshwar</creatorcontrib><creatorcontrib>Gustot, Thierry</creatorcontrib><creatorcontrib>Albillos, Agustin</creatorcontrib><creatorcontrib>Banares, Rafael</creatorcontrib><creatorcontrib>Jarcuska, Peter</creatorcontrib><creatorcontrib>Steib, Christian</creatorcontrib><creatorcontrib>Reiberger, Thomas</creatorcontrib><creatorcontrib>Acevedo, Juan</creatorcontrib><creatorcontrib>Gatti, Pietro</creatorcontrib><creatorcontrib>Shawcross, Debbie L</creatorcontrib><creatorcontrib>Zeuzem, Stefan</creatorcontrib><creatorcontrib>Zipprich, Alexander</creatorcontrib><creatorcontrib>Piano, Salvatore</creatorcontrib><creatorcontrib>Berg, Thomas</creatorcontrib><creatorcontrib>Bruns, Tony</creatorcontrib><creatorcontrib>Danielsen, Karen Vagner</creatorcontrib><creatorcontrib>Coenraad, Minneke</creatorcontrib><creatorcontrib>Merli, Manuela</creatorcontrib><creatorcontrib>Stauber, Rudolf</creatorcontrib><creatorcontrib>Zoller, Heinz</creatorcontrib><creatorcontrib>Ramos, Jose Presa</creatorcontrib><creatorcontrib>Sole, Cristina</creatorcontrib><creatorcontrib>Soriano, German</creatorcontrib><creatorcontrib>de Gottardi, Andrea</creatorcontrib><creatorcontrib>Gronbaek, Henning</creatorcontrib><creatorcontrib>Saliba, Faouzi</creatorcontrib><creatorcontrib>Trautwein, Christian</creatorcontrib><creatorcontrib>Kani, Haluk Tarik</creatorcontrib><creatorcontrib>Francque, Sven</creatorcontrib><creatorcontrib>Ryder, Stephen</creatorcontrib><creatorcontrib>Nahon, Pierre</creatorcontrib><creatorcontrib>Romero-Gomez, Manuel</creatorcontrib><creatorcontrib>Van Vlierberghe, Hans</creatorcontrib><creatorcontrib>Francoz, Claire</creatorcontrib><creatorcontrib>Manns, Michael</creatorcontrib><creatorcontrib>Garcia-Lopez, Elisabet</creatorcontrib><creatorcontrib>Tufoni, Manuel</creatorcontrib><creatorcontrib>Amoros, Alex</creatorcontrib><creatorcontrib>Pavesi, Marco</creatorcontrib><creatorcontrib>Sanchez, Cristina</creatorcontrib><creatorcontrib>Praktiknjo, Michael</creatorcontrib><creatorcontrib>Curto, Anna</creatorcontrib><creatorcontrib>Pitarch, Carla</creatorcontrib><creatorcontrib>Putignano, Antonella</creatorcontrib><creatorcontrib>Moreno, Esau</creatorcontrib><creatorcontrib>Bernal, William</creatorcontrib><creatorcontrib>Aguilar, Ferran</creatorcontrib><creatorcontrib>Claria, Joan</creatorcontrib><creatorcontrib>Ponzo, Paola</creatorcontrib><creatorcontrib>Vitalis, Zsuzsanna</creatorcontrib><creatorcontrib>Zaccherini, Giacomo</creatorcontrib><creatorcontrib>Balogh, Boglarka</creatorcontrib><creatorcontrib>Gerbes, Alexander</creatorcontrib><creatorcontrib>Vargas, Victor</creatorcontrib><creatorcontrib>Alessandria, Carlo</creatorcontrib><creatorcontrib>Bernardi, Mauro</creatorcontrib><creatorcontrib>Gines, Pere</creatorcontrib><creatorcontrib>Moreau, Richard</creatorcontrib><creatorcontrib>Angeli, Paolo</creatorcontrib><creatorcontrib>Jalan, Rajiv</creatorcontrib><creatorcontrib>Arroyo, Vicente</creatorcontrib><creatorcontrib>Maschmeier, Miriam</creatorcontrib><creatorcontrib>Semela, David</creatorcontrib><creatorcontrib>Elkrief, Laure</creatorcontrib><creatorcontrib>Elsharkawy, Ahmed</creatorcontrib><creatorcontrib>Tornai, Tamas</creatorcontrib><creatorcontrib>Tornai, Istvan</creatorcontrib><creatorcontrib>Altorjay, Istvan</creatorcontrib><creatorcontrib>Antognoli, Agnese</creatorcontrib><creatorcontrib>Baldassarre, Maurizio</creatorcontrib><creatorcontrib>Gagliardi, Martina</creatorcontrib><creatorcontrib>Bertoli, Eleonora</creatorcontrib><creatorcontrib>Mareso, Sara</creatorcontrib><creatorcontrib>Brocca, Alessandra</creatorcontrib><creatorcontrib>Campion, Daniela</creatorcontrib><creatorcontrib>Saracco, Giorgio Maria</creatorcontrib><creatorcontrib>Rizzo, Martina</creatorcontrib><creatorcontrib>Lehmann, Jennifer</creatorcontrib><creatorcontrib>Pohlmann, Alessandra</creatorcontrib><creatorcontrib>Brol, Maximilian J</creatorcontrib><creatorcontrib>Chang, Johannes</creatorcontrib><creatorcontrib>Schierwagen, Robert</creatorcontrib><creatorcontrib>Sola, Elsa</creatorcontrib><creatorcontrib>Amari, Nesrine</creatorcontrib><creatorcontrib>Rodriguez, Miguel</creatorcontrib><creatorcontrib>Nevens, Frederik</creatorcontrib><creatorcontrib>Clemente, Ana</creatorcontrib><creatorcontrib>Janicko, Martin</creatorcontrib><creatorcontrib>Markwardt, Daniel</creatorcontrib><creatorcontrib>Mandorfer, Mattias</creatorcontrib><title>PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis</title><title>JOURNAL OF HEPATOLOGY</title><description>BACKGROUND & AIMS: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. LAY SUMMARY: 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.</description><issn>0168-8278</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>FZOIL</sourceid><recordid>eNqVjrFuwkAQRK8gEiTwD9tRREgHNsbUQBQ6FNFbp_UaLxx3lncdyN_HivgAUk0x72lmYEZ2nuWzfLHKh-ZV5GytTew6HZlw-Npt95sjcElBuWISaFpCblidcjgBffeFgBOJyE6phBtrDVoToOfA6Dxg7FohiBU47JT8D5SE8dpQkD8DuW3rKCxj81I5LzR55JuZfuyOm8_ZpfPU9UtFKY1DKuaLJF1mq3xdZFma9m__Q74_RxZ61-QX5ctY1Q</recordid><startdate>202105</startdate><enddate>202105</enddate><creator>Trebicka, Jonel</creator><creator>Fernandez, Javier</creator><creator>Papp, Maria</creator><creator>Caraceni, Paolo</creator><creator>Laleman, Wim</creator><creator>Gambino, Carmine</creator><creator>Giovo, Ilaria</creator><creator>Uschner, Frank Erhard</creator><creator>Jansen, Christian</creator><creator>Jimenez, Cesar</creator><creator>Mookerjee, Rajeshwar</creator><creator>Gustot, Thierry</creator><creator>Albillos, Agustin</creator><creator>Banares, Rafael</creator><creator>Jarcuska, Peter</creator><creator>Steib, Christian</creator><creator>Reiberger, Thomas</creator><creator>Acevedo, Juan</creator><creator>Gatti, Pietro</creator><creator>Shawcross, Debbie L</creator><creator>Zeuzem, Stefan</creator><creator>Zipprich, Alexander</creator><creator>Piano, Salvatore</creator><creator>Berg, Thomas</creator><creator>Bruns, Tony</creator><creator>Danielsen, Karen Vagner</creator><creator>Coenraad, Minneke</creator><creator>Merli, Manuela</creator><creator>Stauber, Rudolf</creator><creator>Zoller, Heinz</creator><creator>Ramos, Jose Presa</creator><creator>Sole, Cristina</creator><creator>Soriano, German</creator><creator>de Gottardi, Andrea</creator><creator>Gronbaek, Henning</creator><creator>Saliba, Faouzi</creator><creator>Trautwein, Christian</creator><creator>Kani, Haluk Tarik</creator><creator>Francque, Sven</creator><creator>Ryder, Stephen</creator><creator>Nahon, Pierre</creator><creator>Romero-Gomez, Manuel</creator><creator>Van Vlierberghe, Hans</creator><creator>Francoz, Claire</creator><creator>Manns, Michael</creator><creator>Garcia-Lopez, Elisabet</creator><creator>Tufoni, Manuel</creator><creator>Amoros, Alex</creator><creator>Pavesi, Marco</creator><creator>Sanchez, Cristina</creator><creator>Praktiknjo, Michael</creator><creator>Curto, Anna</creator><creator>Pitarch, Carla</creator><creator>Putignano, Antonella</creator><creator>Moreno, Esau</creator><creator>Bernal, William</creator><creator>Aguilar, Ferran</creator><creator>Claria, Joan</creator><creator>Ponzo, Paola</creator><creator>Vitalis, Zsuzsanna</creator><creator>Zaccherini, Giacomo</creator><creator>Balogh, Boglarka</creator><creator>Gerbes, Alexander</creator><creator>Vargas, Victor</creator><creator>Alessandria, Carlo</creator><creator>Bernardi, Mauro</creator><creator>Gines, Pere</creator><creator>Moreau, 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Frederik</creator><creator>Clemente, Ana</creator><creator>Janicko, Martin</creator><creator>Markwardt, Daniel</creator><creator>Mandorfer, Mattias</creator><general>ELSEVIER</general><scope>FZOIL</scope></search><sort><creationdate>202105</creationdate><title>PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis</title><author>Trebicka, Jonel ; Fernandez, Javier ; Papp, Maria ; Caraceni, Paolo ; Laleman, Wim ; Gambino, Carmine ; Giovo, Ilaria ; Uschner, Frank Erhard ; Jansen, Christian ; Jimenez, Cesar ; Mookerjee, Rajeshwar ; Gustot, Thierry ; Albillos, Agustin ; Banares, Rafael ; Jarcuska, Peter ; Steib, Christian ; Reiberger, Thomas ; Acevedo, Juan ; Gatti, Pietro ; Shawcross, Debbie L ; Zeuzem, Stefan ; Zipprich, Alexander ; Piano, Salvatore ; Berg, Thomas ; Bruns, Tony ; Danielsen, Karen Vagner ; Coenraad, Minneke ; Merli, Manuela ; Stauber, Rudolf ; Zoller, Heinz ; Ramos, Jose Presa ; Sole, Cristina ; Soriano, German ; de Gottardi, Andrea ; Gronbaek, Henning ; Saliba, Faouzi ; Trautwein, Christian ; Kani, Haluk Tarik ; Francque, Sven ; Ryder, Stephen ; Nahon, Pierre ; Romero-Gomez, Manuel ; Van Vlierberghe, Hans ; Francoz, Claire ; Manns, Michael ; Garcia-Lopez, Elisabet ; Tufoni, Manuel ; Amoros, Alex ; Pavesi, Marco ; Sanchez, Cristina ; Praktiknjo, Michael ; Curto, Anna ; Pitarch, Carla ; Putignano, Antonella ; Moreno, Esau ; Bernal, William ; Aguilar, Ferran ; Claria, Joan ; Ponzo, Paola ; Vitalis, Zsuzsanna ; Zaccherini, Giacomo ; Balogh, Boglarka ; Gerbes, Alexander ; Vargas, Victor ; Alessandria, Carlo ; Bernardi, Mauro ; Gines, Pere ; Moreau, Richard ; Angeli, Paolo ; Jalan, Rajiv ; Arroyo, Vicente ; Maschmeier, Miriam ; Semela, David ; Elkrief, Laure ; Elsharkawy, Ahmed ; Tornai, Tamas ; Tornai, Istvan ; Altorjay, Istvan ; Antognoli, Agnese ; Baldassarre, Maurizio ; Gagliardi, Martina ; Bertoli, Eleonora ; Mareso, Sara ; Brocca, Alessandra ; Campion, Daniela ; Saracco, Giorgio Maria ; Rizzo, Martina ; Lehmann, Jennifer ; Pohlmann, Alessandra ; Brol, Maximilian J ; Chang, Johannes ; Schierwagen, Robert ; Sola, Elsa ; Amari, Nesrine ; Rodriguez, Miguel ; Nevens, Frederik ; Clemente, Ana ; Janicko, Martin ; Markwardt, Daniel ; Mandorfer, Mattias</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-kuleuven_dspace_123456789_6644003</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Trebicka, Jonel</creatorcontrib><creatorcontrib>Fernandez, Javier</creatorcontrib><creatorcontrib>Papp, Maria</creatorcontrib><creatorcontrib>Caraceni, Paolo</creatorcontrib><creatorcontrib>Laleman, Wim</creatorcontrib><creatorcontrib>Gambino, Carmine</creatorcontrib><creatorcontrib>Giovo, Ilaria</creatorcontrib><creatorcontrib>Uschner, Frank Erhard</creatorcontrib><creatorcontrib>Jansen, Christian</creatorcontrib><creatorcontrib>Jimenez, Cesar</creatorcontrib><creatorcontrib>Mookerjee, Rajeshwar</creatorcontrib><creatorcontrib>Gustot, Thierry</creatorcontrib><creatorcontrib>Albillos, Agustin</creatorcontrib><creatorcontrib>Banares, Rafael</creatorcontrib><creatorcontrib>Jarcuska, Peter</creatorcontrib><creatorcontrib>Steib, Christian</creatorcontrib><creatorcontrib>Reiberger, Thomas</creatorcontrib><creatorcontrib>Acevedo, Juan</creatorcontrib><creatorcontrib>Gatti, Pietro</creatorcontrib><creatorcontrib>Shawcross, Debbie L</creatorcontrib><creatorcontrib>Zeuzem, Stefan</creatorcontrib><creatorcontrib>Zipprich, Alexander</creatorcontrib><creatorcontrib>Piano, Salvatore</creatorcontrib><creatorcontrib>Berg, Thomas</creatorcontrib><creatorcontrib>Bruns, Tony</creatorcontrib><creatorcontrib>Danielsen, Karen Vagner</creatorcontrib><creatorcontrib>Coenraad, Minneke</creatorcontrib><creatorcontrib>Merli, Manuela</creatorcontrib><creatorcontrib>Stauber, Rudolf</creatorcontrib><creatorcontrib>Zoller, Heinz</creatorcontrib><creatorcontrib>Ramos, Jose Presa</creatorcontrib><creatorcontrib>Sole, Cristina</creatorcontrib><creatorcontrib>Soriano, German</creatorcontrib><creatorcontrib>de Gottardi, Andrea</creatorcontrib><creatorcontrib>Gronbaek, Henning</creatorcontrib><creatorcontrib>Saliba, Faouzi</creatorcontrib><creatorcontrib>Trautwein, Christian</creatorcontrib><creatorcontrib>Kani, Haluk Tarik</creatorcontrib><creatorcontrib>Francque, Sven</creatorcontrib><creatorcontrib>Ryder, Stephen</creatorcontrib><creatorcontrib>Nahon, Pierre</creatorcontrib><creatorcontrib>Romero-Gomez, Manuel</creatorcontrib><creatorcontrib>Van Vlierberghe, Hans</creatorcontrib><creatorcontrib>Francoz, Claire</creatorcontrib><creatorcontrib>Manns, Michael</creatorcontrib><creatorcontrib>Garcia-Lopez, Elisabet</creatorcontrib><creatorcontrib>Tufoni, Manuel</creatorcontrib><creatorcontrib>Amoros, Alex</creatorcontrib><creatorcontrib>Pavesi, Marco</creatorcontrib><creatorcontrib>Sanchez, Cristina</creatorcontrib><creatorcontrib>Praktiknjo, Michael</creatorcontrib><creatorcontrib>Curto, Anna</creatorcontrib><creatorcontrib>Pitarch, Carla</creatorcontrib><creatorcontrib>Putignano, Antonella</creatorcontrib><creatorcontrib>Moreno, Esau</creatorcontrib><creatorcontrib>Bernal, William</creatorcontrib><creatorcontrib>Aguilar, Ferran</creatorcontrib><creatorcontrib>Claria, Joan</creatorcontrib><creatorcontrib>Ponzo, Paola</creatorcontrib><creatorcontrib>Vitalis, Zsuzsanna</creatorcontrib><creatorcontrib>Zaccherini, Giacomo</creatorcontrib><creatorcontrib>Balogh, Boglarka</creatorcontrib><creatorcontrib>Gerbes, Alexander</creatorcontrib><creatorcontrib>Vargas, Victor</creatorcontrib><creatorcontrib>Alessandria, Carlo</creatorcontrib><creatorcontrib>Bernardi, Mauro</creatorcontrib><creatorcontrib>Gines, Pere</creatorcontrib><creatorcontrib>Moreau, Richard</creatorcontrib><creatorcontrib>Angeli, Paolo</creatorcontrib><creatorcontrib>Jalan, Rajiv</creatorcontrib><creatorcontrib>Arroyo, Vicente</creatorcontrib><creatorcontrib>Maschmeier, Miriam</creatorcontrib><creatorcontrib>Semela, David</creatorcontrib><creatorcontrib>Elkrief, Laure</creatorcontrib><creatorcontrib>Elsharkawy, Ahmed</creatorcontrib><creatorcontrib>Tornai, Tamas</creatorcontrib><creatorcontrib>Tornai, Istvan</creatorcontrib><creatorcontrib>Altorjay, Istvan</creatorcontrib><creatorcontrib>Antognoli, Agnese</creatorcontrib><creatorcontrib>Baldassarre, Maurizio</creatorcontrib><creatorcontrib>Gagliardi, Martina</creatorcontrib><creatorcontrib>Bertoli, Eleonora</creatorcontrib><creatorcontrib>Mareso, Sara</creatorcontrib><creatorcontrib>Brocca, Alessandra</creatorcontrib><creatorcontrib>Campion, Daniela</creatorcontrib><creatorcontrib>Saracco, Giorgio Maria</creatorcontrib><creatorcontrib>Rizzo, Martina</creatorcontrib><creatorcontrib>Lehmann, Jennifer</creatorcontrib><creatorcontrib>Pohlmann, Alessandra</creatorcontrib><creatorcontrib>Brol, Maximilian J</creatorcontrib><creatorcontrib>Chang, Johannes</creatorcontrib><creatorcontrib>Schierwagen, Robert</creatorcontrib><creatorcontrib>Sola, Elsa</creatorcontrib><creatorcontrib>Amari, Nesrine</creatorcontrib><creatorcontrib>Rodriguez, Miguel</creatorcontrib><creatorcontrib>Nevens, Frederik</creatorcontrib><creatorcontrib>Clemente, Ana</creatorcontrib><creatorcontrib>Janicko, Martin</creatorcontrib><creatorcontrib>Markwardt, Daniel</creatorcontrib><creatorcontrib>Mandorfer, Mattias</creatorcontrib><collection>Lirias (KU Leuven Association)</collection><jtitle>JOURNAL OF HEPATOLOGY</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Trebicka, Jonel</au><au>Fernandez, Javier</au><au>Papp, Maria</au><au>Caraceni, Paolo</au><au>Laleman, Wim</au><au>Gambino, Carmine</au><au>Giovo, Ilaria</au><au>Uschner, Frank Erhard</au><au>Jansen, Christian</au><au>Jimenez, Cesar</au><au>Mookerjee, Rajeshwar</au><au>Gustot, Thierry</au><au>Albillos, Agustin</au><au>Banares, Rafael</au><au>Jarcuska, Peter</au><au>Steib, Christian</au><au>Reiberger, Thomas</au><au>Acevedo, Juan</au><au>Gatti, Pietro</au><au>Shawcross, Debbie L</au><au>Zeuzem, Stefan</au><au>Zipprich, Alexander</au><au>Piano, Salvatore</au><au>Berg, Thomas</au><au>Bruns, Tony</au><au>Danielsen, Karen Vagner</au><au>Coenraad, Minneke</au><au>Merli, Manuela</au><au>Stauber, Rudolf</au><au>Zoller, Heinz</au><au>Ramos, Jose Presa</au><au>Sole, Cristina</au><au>Soriano, German</au><au>de Gottardi, Andrea</au><au>Gronbaek, Henning</au><au>Saliba, Faouzi</au><au>Trautwein, Christian</au><au>Kani, Haluk Tarik</au><au>Francque, Sven</au><au>Ryder, Stephen</au><au>Nahon, Pierre</au><au>Romero-Gomez, Manuel</au><au>Van Vlierberghe, Hans</au><au>Francoz, Claire</au><au>Manns, Michael</au><au>Garcia-Lopez, Elisabet</au><au>Tufoni, Manuel</au><au>Amoros, Alex</au><au>Pavesi, Marco</au><au>Sanchez, Cristina</au><au>Praktiknjo, Michael</au><au>Curto, Anna</au><au>Pitarch, Carla</au><au>Putignano, Antonella</au><au>Moreno, Esau</au><au>Bernal, William</au><au>Aguilar, Ferran</au><au>Claria, Joan</au><au>Ponzo, Paola</au><au>Vitalis, Zsuzsanna</au><au>Zaccherini, Giacomo</au><au>Balogh, Boglarka</au><au>Gerbes, Alexander</au><au>Vargas, Victor</au><au>Alessandria, Carlo</au><au>Bernardi, Mauro</au><au>Gines, Pere</au><au>Moreau, Richard</au><au>Angeli, Paolo</au><au>Jalan, Rajiv</au><au>Arroyo, Vicente</au><au>Maschmeier, Miriam</au><au>Semela, David</au><au>Elkrief, Laure</au><au>Elsharkawy, Ahmed</au><au>Tornai, Tamas</au><au>Tornai, Istvan</au><au>Altorjay, Istvan</au><au>Antognoli, Agnese</au><au>Baldassarre, Maurizio</au><au>Gagliardi, Martina</au><au>Bertoli, Eleonora</au><au>Mareso, Sara</au><au>Brocca, Alessandra</au><au>Campion, Daniela</au><au>Saracco, Giorgio Maria</au><au>Rizzo, Martina</au><au>Lehmann, Jennifer</au><au>Pohlmann, Alessandra</au><au>Brol, Maximilian J</au><au>Chang, Johannes</au><au>Schierwagen, Robert</au><au>Sola, Elsa</au><au>Amari, Nesrine</au><au>Rodriguez, Miguel</au><au>Nevens, Frederik</au><au>Clemente, Ana</au><au>Janicko, Martin</au><au>Markwardt, Daniel</au><au>Mandorfer, Mattias</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis</atitle><jtitle>JOURNAL OF HEPATOLOGY</jtitle><date>2021-05</date><risdate>2021</risdate><volume>74</volume><issue>5</issue><spage>1097</spage><epage>1108</epage><pages>1097-1108</pages><issn>0168-8278</issn><abstract>BACKGROUND & AIMS: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. LAY SUMMARY: 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.</abstract><pub>ELSEVIER</pub><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0168-8278 |
| ispartof | JOURNAL OF HEPATOLOGY, 2021-05, Vol.74 (5), p.1097-1108 |
| issn | 0168-8278 |
| language | eng |
| recordid | cdi_kuleuven_dspace_123456789_664400 |
| source | Lirias (KU Leuven Association); Elsevier ScienceDirect Journals Collection |
| title | PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis |
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