Combination and sequential evaluation of acute-on-chronic liver failure (ACLF) and hyponatremia and prognosis in cirrhotic patients

Baldin, Caroline; Piedade, Juliana; Reis, Vanessa Quadros dos; Valdeolivas, Tatiana; Victor, Lívia; Guimarães, Lívia; Duarte, Joana; Veiga, Zulane; Alcântara, Camila; Fernandes, Flávia; Pereira, João Luiz

doi:10.1016/j.dld.2019.08.013

Cited by 17 publications

(15 citation statements)

References 23 publications

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“…About a quarter of patients with ACLF may have hyponatremia which is an independent predictor of mortality (64,65). In admitted patients with acute decompensated cirrhosis, hyponatremia was seen in up to 25% patients with ACLF compared to 12% patients without ACLF.…”

Section: C) Hyponatremia and Acute On Chronic Liver Failurementioning

confidence: 99%

“…patients who didn't have hyponatremia (35.8% vs 58.7%; p=0.001)(65).In another small observational study presence of hyponatremia at admission, Model of End Stage Liver Disease (MELD) score and performing an invasive procedure were independent predictors to develop ACLF (ACLF ≥ class 2) and consequent death in patients with bacterial infection (SBP/Urinary tract infection/ pneumonia/Cellulitis) and cirrhosis(66). About seventy percent patient with baseline hyponatremia and higher MELD scores developed ACLF(66).…”

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confidence: 96%

“…The score is calculated using the following parameters; age of patient, serum creatinine, INR, total WBC count and serum sodium level. It has been shown to be more accurate as compared to MELD and MELD-Na to predict the overall clinical outcome in these patients(65).Most liver societies recommend infusion of albumin in patients undergoing LVP (≥ 5 liter) to prevent PPCD(67,68). However, the threshold may be lower in patients with ACLF.…”

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confidence: 99%

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Clinical Implications, Evaluation, and Management of Hyponatremia in Cirrhosis

Praharaj

Anand

2022

Journal of Clinical and Experimental Hepatology

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Section: C) Hyponatremia and Acute On Chronic Liver Failurementioning

confidence: 99%

mentioning

confidence: 96%

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confidence: 99%

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Clinical Implications, Evaluation, and Management of Hyponatremia in Cirrhosis

Praharaj

Anand

2022

Journal of Clinical and Experimental Hepatology

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“…73 Severe hyponatremia has been associated with worse outcomes and often coincides with refractory ascites, frequent large volume paracentesis, hepatic encephalopathy, SBP, hepatorenal syndrome (HRS) and acute on chronic liver failure. [74][75][76][77][78] Initial therapies include fluid restriction (1.5-2 liters per day), discontinuation of diuretics, administration of albumin, and the use of hypertonic saline in severe and symptomatic cases. 72 (Table 3) Vaptans are not recommended for correction of hyponatremia due to reports of drug induced liver injury.…”

Section: Hyponatremiamentioning

confidence: 99%

Step by Step: Managing the Complications of Cirrhosis

Pérez¹,

Bolte²,

Bigelow³

et al. 2021

HMER

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According to the Centers for Disease Control and Prevention, chronic liver disease and cirrhosis is the 11th leading cause of death in the United States. Common causes of chronic liver disease include alcohol, viral hepatitis, and non-alcoholic steatohepatitis (NASH). Inflammation is a critical driver in the progression of liver disease to liver fibrosis and ultimately cirrhosis. While the severity of chronic liver disease extends over a continuum, the management is more easily differentiated between compensated and decompensated cirrhosis. In this review, we discuss pathophysiology, clinical features and management of common complications of liver cirrhosis based on literature review and the current clinical practice guidelines of the American Association for the Study of Liver Diseases (AASLD).

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“…Due to its rapidly changing nature, both initial characteristics and dynamic trends of clinical indicators are helpful to predict prognosis in ACLF 11 . Sequential assessment at multiple time-points may accurately reflect the clinical course and the responsiveness to medical treatment, and theoretically improve the prognostic ability compared to a single time-point 12 . This research aimed to build a dynamic prediction model of ACLF using baseline and dynamic clinical indicators, with the purpose to provide a basis for the development of individualized treatment.…”

Section: Introductionmentioning

confidence: 99%

A dynamic prediction model for prognosis of acute-on-chronic liver failure based on the trend of clinical indicators

Cao

et al. 2021

Sci Rep

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Acute-on-chronic liver failure (ACLF) is a dynamic syndrome, and sequential assessments can reflect its prognosis more accurately. Our aim was to build and validate a new scoring system to predict short-term prognosis using baseline and dynamic data in ACLF. We conducted a retrospective cohort analysis of patients with ACLF from three different hospitals in China. To construct the model, we analyzed a training set of 541 patients from two hospitals. The model’s performance was evaluated in a validation set of 130 patients from another center. In the training set, multivariate Cox regression analysis revealed that age, WGO type, basic etiology, total bilirubin, creatinine, prothrombin activity, and hepatic encephalopathy stage were all independent prognostic factors in ACLF. We designed a dynamic trend score table based on the changing trends of these indicators. Furthermore, a logistic prediction model (DP-ACLF) was constructed by combining the sum of dynamic trend scores and baseline prognostic parameters. All prognostic scores were calculated based on the clinical data of patients at the third day, first week, and second week after admission, respectively, and were correlated with the 90-day prognosis by ROC analysis. Comparative analysis showed that the AUC value for DP-ACLF was higher than for other prognostic scores, including Child–Turcotte–Pugh, MELD, MELD-Na, CLIF-SOFA, CLIF-C ACLF, and COSSH-ACLF. The new scoring model, which combined baseline characteristics and dynamic changes in clinical indicators to predict the course of ACLF, showed a better prognostic ability than current scoring systems. Prospective studies are needed to validate these results.

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Combination and sequential evaluation of acute-on-chronic liver failure (ACLF) and hyponatremia and prognosis in cirrhotic patients

Cited by 17 publications

References 23 publications

Clinical Implications, Evaluation, and Management of Hyponatremia in Cirrhosis

Clinical Implications, Evaluation, and Management of Hyponatremia in Cirrhosis

Step by Step: Managing the Complications of Cirrhosis

A dynamic prediction model for prognosis of acute-on-chronic liver failure based on the trend of clinical indicators

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