Bacterial infection‐triggered acute‐on‐chronic liver failure is associated with increased mortality

Mücke, Marcus M.; Rumyantseva, Tatiana; Mücke, Victoria T.; Schwarzkopf, K; Joshi, Sabrina; Kempf, Volkhard A. J.; Welsch, Christoph; Zeuzem, Stefan; Lange, Christian

doi:10.1111/liv.13568

Cited by 95 publications

(88 citation statements)

References 26 publications

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“…Infection is well‐known as a major driving force of liver and kidney deterioration, and this has been indicated as a predictor of mortality in patients with liver failure . Since steroid use is usually contraindicated during infection, patients with infection were excluded from the study upon their admission to hospital.…”

Section: Discussionmentioning

confidence: 99%

“…Infection is well-known as a major driving force of liver and kidney deterioration, and this has been indicated as a predictor of mortality in patients with liver failure. [20][21][22] Since steroid use is usually contraindicated during infection, patients with infection were excluded from the study upon their admission to hospital. In this study, the overall infection rate was significantly higher in the patients treated with steroids than in the control group, and all cases of invasive fungal infection were correlated with steroid use.…”

Section: Discussionmentioning

confidence: 99%

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Steroid treatment in patients with acute‐on‐chronic liver failure precipitated by hepatitis B: A 10‐year cohort study in a university hospital in East China

Huang

Zheng

et al. 2019

J of Digest Diseases

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Objective To investigate retrospectively the efficacy of steroids in patients with acute‐on‐chronic liver failure (ACLF) precipitated by hepatitis B. Methods Patients with ACLF precipitated by hepatitis B were included and categorized according to treatment modalities (steroid vs. control). Survival and clinical characteristics, including patients’ age, baseline ACLF grade, the model for end‐stage liver disease (MELD) score, and occurrence of infection were compared between the two groups. Survival analyses of subgroups classified by their age, ACLF grade and MELD score were performed. Cox regression analyses were conducted to identify factors associated with 60‐day cumulative and transplant‐free mortality. Results From 2007 to 2016, 293 patients with hepatitis B‐precipitated ACLF were recruited, among whom 162 received at least five consecutive doses of corticosteroids. By day 60 transplant‐free survival was 62.6% in the control group compared with 53.7% in the steroid group (P = 0.126). Steroid treatment failed to show a survival benefit in the survival analysis among the subgroup. Within 60 days, pulmonary and overall infections occurred with higher frequency in the steroid‐treated group than in the controls (P = 0.003 and < 0.001, respectively). In the univariate analysis, age, baseline MELD score >20, CLIF consortium (CLIF‐C) ACLF grade 2‐3, pulmonary infection and overall infection were associated with 60‐day mortality. In the multivariate analysis, older age, baseline MELD score >20 and CLIF‐C ACLF grade 2‐3 were independent risk factors of 60‐day mortality. Conclusion Steroid treatment did not improve transplant‐free survival in patients with ACLF precipitated by hepatitis B.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Steroid treatment in patients with acute‐on‐chronic liver failure precipitated by hepatitis B: A 10‐year cohort study in a university hospital in East China

Huang

Zheng

et al. 2019

J of Digest Diseases

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“…Infection and ACLS is a dangerous combination for clinical outcomes for several reasons. In patients with ACLS caused by different etiologies, the presence of bacterial infection was associated with significantly lower 90‐day survival compared with ACLF with no infection . Furthermore, the probability of acquiring infections in ACLS is increased in the presence of cirrhosis .…”

mentioning

confidence: 98%

Pathogenesis of Acute‐on‐Chronic Liver Failure in Patients With Infection

Szabó

2019

Clinical Liver Disease

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“…Altogether, this results in a deprivation of tissues from oxygen and energy and subsequent cell death [25]. Immunosuppression and Risk of Infections Due to the above-described features of profound immunosuppression, patients with liver cirrhosis and in particular patients with ACLF are at high risk of developing infections as well as adverse outcomes of infections [26,27]. In the CANONIC study, 37.3% of patients with ACLF (vs. 25.1% without ACLF) had infections at baseline, including SBP in 9.8%, urinary tract infections in 6%, pneumonia in 7.7%, skin and soft tissue infections in 2.9%, and Candida infections in 3.9% of cases [26].…”

Section: Inflammation As a Driver Of Organ Failuresmentioning

confidence: 99%

Immunodysfunction in Acute-on-Chronic Liver Failure

Lange¹,

Moreau²

2018

Visc Med

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Background: Increasing evidence reveals a close and reciprocal link between acute-on-chronic liver failure (ACLF) and immunodysfunction. Methods: A literature search in PubMed and abstract databases of relevant congresses was performed. Results: Important characteristics of liver cirrhosis like tissue hypoxia, cell death, or bacterial translocation maintain a state of chronic inflammation. Precipitating events of ACLF such as infections or alcoholic hepatitis are capable of strongly augmenting cirrhosis-associated systemic inflammation to grades sufficient to induce ACLF-defining organ failures. Chronic systemic inflammation, however, is causally linked to profound immunosuppression. As a consequence, patients with liver cirrhosis and in particular with ACLF are at high risk for severe infections. Promising strategies to ameliorate immunodysfunction, like albumin substitution, administration of recombinant interleukin-22 or granulocyte colony-stimulating factor, antibiotic prophylaxis, or anticoagulation, are under development and offer the chance to specifically prevent and treat ACLF. Conclusion: A better understanding of the immunopathology of ACLF will likely translate into the implementation of specific therapeutic modalities to prevent and overcome ACLF.

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Bacterial infection‐triggered acute‐on‐chronic liver failure is associated with increased mortality

Abstract: This study confirmed the EASL-CLIF-Consortium definition of ACLF as strong predictor of mortality in patients with acute decompensation of cirrhosis. However, we have observed a remarkably higher mortality in infection-triggered ACLF compared to other precipitating events.

Cited by 95 publications

References 26 publications

Steroid treatment in patients with acute‐on‐chronic liver failure precipitated by hepatitis B: A 10‐year cohort study in a university hospital in East China

Steroid treatment in patients with acute‐on‐chronic liver failure precipitated by hepatitis B: A 10‐year cohort study in a university hospital in East China

Pathogenesis of Acute‐on‐Chronic Liver Failure in Patients With Infection

Immunodysfunction in Acute-on-Chronic Liver Failure

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