Hemodynamic Studies in Acute-on-Chronic Liver Failure

Kumar, Ashish; Das, Kunal; Sharma, Praveen; Mehta, Vimal; Sharma, Barjesh Chander; Sarin, Shiv Kumar

doi:10.1007/s10620-008-0421-9

Cited by 53 publications

(38 citation statements)

References 29 publications

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“…Hyperdynamic circulation and portal hypertension characterize ACLF, partially because of circulating mediators. While patients with ACLF with small varices had HVPG values (13.2 (±5.5) mm Hg) comparable with those of compensated cirrhotic patients, those with large varices had HVPG values comparable with those of decompensated cirrhotic patients (18.2 (±6.5) mm Hg) [59]. The data clearly showed that patients with small varices and lower HVPG levels have a higher chance of recovery after the acute insult settles down.…”

Section: Hemodynamics In Aclfmentioning

confidence: 73%

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the study of the liver (APASL)

et al. 2008

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The Asian Pacific Association for the Study of the Liver (APASL) set up a working party on acute-on-chronic liver failure (ACLF) in 2004, with a mandate to develop consensus guidelines on various aspects of ACLF relevant to disease patterns and clinical practice in the Asia-Pacific region. Experts predominantly from the Asia-Pacific region constituted this working party and were requested to identify different issues of ACLF and develop the consensus guidelines. A 2-day meeting of the working party was held on January 22-23, 2008, at New Delhi, India, to discuss and finalize the consensus statements. Only those statements that were unanimously approved by the experts were accepted. These statements were circulated to all the experts and subsequently presented at the Annual Conference of the APASL at Seoul, Korea, in March 2008. The consensus statements along with relevant background information are presented in this review.

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Section: Hemodynamics In Aclfmentioning

confidence: 73%

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the study of the liver (APASL)

et al. 2008

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“…In a study from Delhi in adult patients, the predictors of mortality were encephalopathy, hepatorenal syndrome, GI bleed, platelets, serum sodium, HBV DNA and hepatic venous pressure gradient (HVPG) on univariate analysis, whereas on multivariate analysis only encephalopathy, platelet and HVPG independently predicted mortality. Etiology made no difference in mortality [11].…”

Section: Discussionmentioning

confidence: 90%

Predictors of outcome in acute-on-chronic liver failure in children

et al. 2010

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Background and aims Acute-on-chronic liver failure (ACLF) is associated with a high mortality rate in the absence of liver transplantation. There is limited data on predictors of survival in ACLF in children. Therefore, we prospectively studied the predictors of outcome of ACLF in children. Methods A prospective evaluation of 31 children in the age group of 1-16 years who fulfilled the criteria for ACLF according to Asian Pacific Association for the Study of the Liver (APASL) 2008 consensus was done. All consecutive children were evaluated for etiology, diagnosis and severity of ACLF. For grading of organ dysfunction, the sequential organ failure assessment (SOFA) score was calculated. SOFA constitutes the parameters of respiration, coagulation, cardiovascular system, central nervous system, and renal and liver functions. We evaluated possible correlation between outcomes and different variables. Results Of the 31 children who fulfilled the criteria for ACLF, the common underlying chronic liver diseases (CLD) were autoimmune hepatitis (AIH) in 41.9% and Wilson disease in 41.9% of the patients. Superinfection with hepatitis A virus (HAV) (41.9%) was the most common etiology of acute deterioration. To find the best predictor for outcome, linear regression analysis was performed. Multivariate analysis revealed that the SOFA score and the International Normalized Ratio (INR) were predictors of survival. Six (19.4%) patients died. Causes of death were multiorgan failure in four and liver failure in two patients. Conclusion The mortality in ACLF is 19.4% and the causes of death were multiorgan failure and liver failure. The SOFA score and INR were predictors of outcome of ACLF in children.

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“…Eventhough the systemic hemodynamic alterations in ACLF are similar to patients with decompensated cirrhotics [79], the pathogenesis of renal dysfunction in ACLF is quite different in these patients as a major role is played by SIRS and subsequent sepsis [80]. Hence, both the circulatory and immune dysfunction are responsible for renal injury in these patients.…”

Section: Renal Failurementioning

confidence: 99%

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014

et al. 2014

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The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set up in 2004 on acute-on-chronic liver failure (ACLF) was published in 2009. Due to the rapid advancements in the knowledge and available information, a consortium of members from countries across Asia Pacific, ''APASL ACLF Research Consortium (AARC),'' was formed in 2012. A large cohort of retrospective and prospective data of ACLF patients was collated and followed up in this data base. The current ACLF definition was reassessed based on the new AARC data base. These initiatives were concluded on a 2-day meeting in February 2014 at New Delhi and led to the development of the final AARC consensus. Only those statements which were based on the evidence and were unanimously recommended were accepted. These statements were circulated again to all the experts and subsequently presented at the annual conference of the APASL at Brisbane, on March 14, 2014. The suggestions from the delegates were analyzed by the expert panel, and the modifications in the consensus were made. The final consensus and guidelines document was prepared. After detailed deliberations and data analysis, the

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Hemodynamic Studies in Acute-on-Chronic Liver Failure

Abstract: The systemic hemodynamics in patients with ACLF is similar to that in decompensated cirrhotics. The portal pressure in these patients is higher than that in the compensated cirrhotics, and in the subgroup with large varices, it becomes similar to that of decompensated cirrhotics.

Cited by 53 publications

References 29 publications

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the study of the liver (APASL)

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the study of the liver (APASL)

Predictors of outcome in acute-on-chronic liver failure in children

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014

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