Polymorphisms in the IL‐1 gene cluster influence systemic inflammation in patients at risk for acute‐on‐chronic liver failure

Hepatology ◽  
2016 ◽  
Vol 65 (1) ◽  
pp. 202-216 ◽  
Author(s):  
José Alcaraz‐Quiles ◽  
Esther Titos ◽  
Mireia Casulleras ◽  
Marco Pavesi ◽  
Cristina López‐Vicario ◽  
...  
Keyword(s):  
At Risk ◽  
Liver Failure ◽  
Gene Cluster ◽  
Systemic Inflammation ◽  
Chronic Liver ◽  
Chronic Liver Failure ◽  
Patients At Risk

scholarly journals Systemic inflammation in decompensated cirrhosis: Characterization and role in acute-on-chronic liver failure

Hepatology ◽  
2016 ◽  
Vol 64 (4) ◽  
pp. 1249-1264 ◽  
Author(s):  
Joan Clària ◽  
Rudolf E. Stauber ◽  
Minneke J. Coenraad ◽  
Richard Moreau ◽  
Rajiv Jalan ◽  
...  
Keyword(s):  
Liver Failure ◽  
Systemic Inflammation ◽  
Chronic Liver ◽  
Decompensated Cirrhosis ◽  
Chronic Liver Failure

scholarly journals Bacterial and fungal infections in acute-on-chronic liver failure: prevalence, characteristics and impact on prognosis

Gut ◽  
2017 ◽  
Vol 67 (10) ◽  
pp. 1870-1880 ◽  
Author(s):  
Javier Fernández ◽  
Juan Acevedo ◽  
Reiner Wiest ◽  
Thierry Gustot ◽  
Alex Amoros ◽  
...  
Keyword(s):  
Liver Failure ◽  
Systemic Inflammation ◽  
Bacterial Infections ◽  
Clinical Course ◽  
Fungal Infections ◽  
Chronic Liver ◽  
Chronic Liver Failure ◽  
Bacterial Peritonitis ◽  
Probability Of Survival

Bacterial infection is a frequent trigger of acute-on-chronic liver failure (ACLF), syndrome that could also increase the risk of infection. This investigation evaluated prevalence and characteristics of bacterial and fungal infections causing and complicating ACLF, predictors of follow-up bacterial infections and impact of bacterial infections on survival.Patients407 patients with ACLF and 235 patients with acute decompensation (AD).Results152 patients (37%) presented bacterial infections at ACLF diagnosis; 46%(n=117) of the remaining 255 patients with ACLF developed bacterial infections during follow-up (4 weeks). The corresponding figures in patients with AD were 25% and 18% (p<0.001). Severe infections (spontaneous bacterial peritonitis, pneumonia, severe sepsis/shock, nosocomial infections and infections caused by multiresistant organisms) were more prevalent in patients with ACLF. Patients with ACLF and bacterial infections (either at diagnosis or during follow-up) showed higher grade of systemic inflammation at diagnosis of the syndrome, worse clinical course (ACLF 2-3 at final assessment: 47% vs 26%; p<0.001) and lower 90-day probability of survival (49% vs 72.5%;p<0.001) than patients with ACLF without infection. Bacterial infections were independently associated with mortality in patients with ACLF-1 and ACLF-2. Fungal infections developed in 9 patients with ACLF (2%) and in none with AD, occurred mainly after ACLF diagnosis (78%) and had high 90-day mortality (71%).ConclusionBacterial infections are extremely frequent in ACLF. They are severe and associated with intense systemic inflammation, poor clinical course and high mortality. Patients with ACLF are highly predisposed to develop bacterial infections within a short follow-up period and could benefit from prophylactic strategies.

scholarly journals Acute-on-Chronic Liver Failure From Chronic-Hepatitis-B, Who Is the Behind Scenes

2020 ◽  
Vol 11 ◽  
Author(s):  
Qian Li ◽  
Jun Wang ◽  
Mengji Lu ◽  
Yuanwang Qiu ◽  
Hongzhou Lu
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis B ◽  
Liver Failure ◽  
Chronic Hepatitis B ◽  
Systemic Inflammation ◽  
Inflammatory Responses ◽  
Treatment Strategies ◽  
Chronic Liver ◽  
Chronic Liver Failure ◽  
Immune Imbalance

Acute-on-chronic liver failure (ACLF) is an acute syndrome accompanied with decompensation of cirrhosis, organ failure with high 28-day mortality rate. Systemic inflammation is the main feature of ACLF, and poor outcome is closely related with exacerbated systemic inflammatory responses. It is well known that severe systemic inflammation is an important event in chronic hepatitis B (CHB)-ACLF, which eventually leads to liver injury. However, the initial CHB-ACLF events are unclear; moreover, the effect of these events on host immunity as well as that of immune imbalance on CHB-ACLF progression are unknown. Here, we investigate the initial events of ACLF progression, discuss possible mechanisms underlying ACLF progression, and provide a new model for ACLF prediction and treatment. We review the characteristics of ACLF, and consider its plausible immune predictors and alternative treatment strategies.

Leveraging omics to understand the molecular basis of acute-on-chronic liver failure

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Joan Clària
Keyword(s):  
Liver Failure ◽  
Organ Failure ◽  
Systemic Inflammation ◽  
Chronic Liver ◽  
Decompensated Cirrhosis ◽  
Chronic Liver Failure ◽  
Short Term Mortality ◽  
Novel Biomarkers ◽  
Molecular Patterns ◽  
Damage Associated Molecular Patterns

Abstract Acute-on-chronic liver failure (ACLF) is a complex syndrome that develops in patients with acutely decompensated cirrhosis. In this condition, dysbalanced immune function and excessive systemic inflammation are closely associated with organ failure and high short-term mortality. In this review, we describe how omic technologies have contributed to the characterization of the hyperinflammatory state in patients with acutely decompensated cirrhosis developing ACLF, with special emphasis on the role of metabolomics, lipidomics and transcriptomics in profiling the triggers (pathogen- and damage-associated molecular patterns [PAMPs and DAMPs]) and effector molecules (cytokines, chemokines, growth factors and bioactive lipid mediators) that lead to activation of the innate immune system. This review also describes how omic approaches can be invaluable tools to accelerate the identification of novel biomarkers that could guide the implementation of novel therapies/interventions aimed at protecting these patients from excessive systemic inflammation and organ failure.

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