Acute-on-chronic liver failure: Definitions, pathophysiology and principles of treatment
| Autor: | Richard Moreau, Giacomo Zaccherini, Emmanuel Weiss |
|---|---|
| Přispěvatelé: | Zaccherini G., Weiss E., Moreau R. |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Cirrhosis
medicine.medical_treatment COSSH Chinese Group on the Study of Severe Hepatitis INR international normalised ratio Review Liver transplantation Systemic inflammation Chronic liver disease EASL European Association for the Study of the Liver - Chronic Liver Liver disease CLIF Chronic Liver Failure-Consortium Model for End-Stage Liver Disease Bacterial infections PRR pattern-recognition receptors Immunology and Allergy Gastroenterology Acute kidney injury ICU intensive care unit medicine.symptom TLR Toll-like receptor medicine.medical_specialty Immunopathology Acute decompensation AKI acute kidney injury AARC APASL ACLF Research Consortium MELD model for end-stage liver disease ER endoplasmic reticulum PAMPs pathogen-associated molecular patterns Intensive care Internal Medicine medicine Sterile inflammation Intensive care medicine OF organ failure UNOS United Network for Organ Sharing NO nitric oxide Hepatology business.industry Inflammatory response medicine.disease APASL Asian Pacific Association for the Study of the Liver HMGB1 high mobility group box 1 Metabolism Multiorgan failure NACSELD North American Consortium for the Study of End-stage Liver Disease Bacterial translocation ACLF acute-on-chronic liver failure DAMPs damage-associated molecular patterns Bacterial infection business |
| Zdroj: | JHEP Reports |
| ISSN: | 2589-5559 |
| Popis: | Summary The term acute-on-chronic liver failure (ACLF) defines an abrupt and life-threatening worsening of clinical conditions in patients with cirrhosis or chronic liver disease. In recent years, different definitions and diagnostic criteria for the syndrome have been proposed by the major international scientific societies. The main controversies relate to the type of acute insult (specifically hepatic or also extrahepatic), the stage of underlying liver disease (cirrhosis or chronic hepatitis) and the concomitant extrahepatic organ failure(s) that should be considered in the definition of ACLF. Therefore, different severity criteria and prognostic scores have been proposed and validated. Current evidence shows that the pathophysiology of ACLF is closely associated with an intense systemic inflammation sustained by circulating pathogen-associated molecular patterns and damage-associated molecular patterns. The development of organ failures may be a result of a combination of tissue hypoperfusion, direct immune-mediated damage and mitochondrial dysfunction. Management of ACLF is currently based on the supportive treatment of organ failures, mainly in an intensive care setting. For selected patients, liver transplantation is an effective treatment that offers a good long-term prognosis. Future studies on potential mechanistic treatments that improve patient survival are eagerly awaited. |
| Databáze: | OpenAIRE |
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