Sex disparities in acute-on-chronic liver failure: From admission to the intensive care unit to liver transplantation.

Autor: Cerutti E; Department of Anesthesia, Transplant and Surgical Intensive Care, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy., D'Arcangelo F; Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy; Gastroenterology and Multivisceral Transplant Unit, Padua University Hospital, Padua, Italy., Becchetti C; Hepatology and Gastroenterology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy., Cilla M; Center for Liver Disease, Division of Internal Medicine and Hepatology, IRCCS Ospedale San Raffaele, 20132 Milan, Italy., Cossiga V; Diseases of the Liver and Biliary System Unit, Department of Clinical Medicine and Surgery, University of Naples 'Federico II', 80131 Naples, Italy., Guarino M; Diseases of the Liver and Biliary System Unit, Department of Clinical Medicine and Surgery, University of Naples 'Federico II', 80131 Naples, Italy., Invernizzi F; Center for Liver Disease, Division of Internal Medicine and Hepatology, IRCCS Ospedale San Raffaele, 20132 Milan, Italy., Lapenna L; Department of Translational and Precision Medicine, Sapienza University of Rome, Italy., Lavezzo B; Emergency Department, Anesthesia and Intensive Care Unit, SS Annunziata Hospital, Savigliano ASL Cuneo, Italy., Marra F; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy., Merli M; Department of Translational and Precision Medicine, Sapienza University of Rome, Italy., Morelli MC; Internal Medicine Unit for the Treatment of Severe Organ Failure, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy., Toniutto P; Hepatology and Liver Transplantation Unit, Academic Hospital, University of Udine, Udine, Italy., Burra P; Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy; Gastroenterology and Multivisceral Transplant Unit, Padua University Hospital, Padua, Italy. Electronic address: burra@unipd.it., Zanetto A; Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy; Gastroenterology and Multivisceral Transplant Unit, Padua University Hospital, Padua, Italy.
Jazyk: angličtina
Zdroj: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver [Dig Liver Dis] 2024 Aug 19. Date of Electronic Publication: 2024 Aug 19.
DOI: 10.1016/j.dld.2024.08.002
Abstrakt: Acute-on-chronic liver failure (ACLF) is a severe clinical syndrome characterized by acute liver decompensation in patients with chronic liver disease, marked by systemic inflammation and systemic organ failure. In this review, we discussed sex-related disparities in the incidence, prognosis, and access to liver transplantation (LT) for patients with ACLF, particularly during Intensive Care Unit (ICU) management. Some studies have suggested that ACLF is more prevalent among male patients admitted to the ICU, and they have higher mortality rates than females. Available prognostic scores, such as CLIF-C or TAM-score, lack sex-specific adjustments. Sarcopenia seems to enhance the accuracy of these scores though this is observed only in male individuals. LT is the only effective treatment for patients with ACLF grade 2-3 who do not respond to medical therapies. Sex-related disparities occur in both access to LT and post-transplant outcomes, although the influence of sex on the prevalence, clinical course, and listing for LT in ACLF remains largely undetermined. A sex-orientated analysis of ICU outcomes in ACLF would facilitate the development of sex-orientated management strategies, thereby improving patients' outcomes.
Competing Interests: Declaration of competing interest On behalf of all Authors, we confirm that we have no conflict of interest to disclose.
(Copyright © 2024 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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