In:
PLOS ONE, Public Library of Science (PLoS), Vol. 16, No. 4 ( 2021-4-13), p. e0250062-
Abstract:
Acute decompensation (AD) of liver cirrhosis (LC) and subsequent acute-on-chronic liver failure (ACLF) are fatal and impair quality of life. Insufficient knowledge of the highly heterogeneous natural history of LC, including decompensation, re-compensation, and possible recurrent decompensation, hinders the development and application of novel therapeutics. Approximately 10%-50% of AD/ACLF is reported to be precipitated by any indeterminate (unidentifiable, cryptogenic, or unknown) acute insults; however, its clinical characteristics are unclear. Methods We conducted a single-center observational study of 2165 consecutively admitted patients with LC from January 2012 to December 2019. A total of 466 episodes of AD/ACLF in 285 patients, including their 285 first indexed AD/ACLF, were extracted for analysis. Stratified analyses of different acute precipitants, classified as indeterminate (AD/ACLF IND ), bacterial infection (AD/ACLF BAC ), gastrointestinal bleeding, active alcoholism, and miscellaneous, were performed. Results AD/ACLF IND was the leading acute precipitant (28%), followed by AD/ACLF BAC (23%). AD/ACLF IND showed better survival outcomes than AD/ACLF BAC ( P = 0.03); however, hyperbilirubinemia, hyponatremia, or leukocytosis significantly and uniquely characterized subgroups of AD/ACLF IND with comparable or even worse survival outcomes than those of AD/ACLF BAC . Patients with subsequent AD/ACLF significantly tended to suffer from AD/ACLF with any organ failure in AD/ACLF IND but not in AD/ACLF BAC ( P = 0.004, for trend). In competing risk analysis, patients with AD/ACLF IND were significantly more vulnerable to suffer from recurrent episodes of AD/ACLF within 180 days, compared to those triggered by other precipitants ( P = 0.04). Conclusions AD/ACLF IND , the leading acute precipitant, also plays a role in subsequent AD/ACLF. An abruptly exacerbating, remitting, and relapsing nature of systemic inflammation underlying AD/ACLF may also be useful for risk estimation.
Type of Medium:
Online Resource
ISSN:
1932-6203
DOI:
10.1371/journal.pone.0250062
DOI:
10.1371/journal.pone.0250062.g001
DOI:
10.1371/journal.pone.0250062.g002
DOI:
10.1371/journal.pone.0250062.g003
DOI:
10.1371/journal.pone.0250062.g004
DOI:
10.1371/journal.pone.0250062.t001
DOI:
10.1371/journal.pone.0250062.t002
DOI:
10.1371/journal.pone.0250062.t003
DOI:
10.1371/journal.pone.0250062.s001
DOI:
10.1371/journal.pone.0250062.s002
DOI:
10.1371/journal.pone.0250062.s003
DOI:
10.1371/journal.pone.0250062.s004
DOI:
10.1371/journal.pone.0250062.s005
DOI:
10.1371/journal.pone.0250062.s006
DOI:
10.1371/journal.pone.0250062.s007
DOI:
10.1371/journal.pone.0250062.s008
DOI:
10.1371/journal.pone.0250062.r001
DOI:
10.1371/journal.pone.0250062.r002
DOI:
10.1371/journal.pone.0250062.r003
DOI:
10.1371/journal.pone.0250062.r004
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2021
detail.hit.zdb_id:
2267670-3
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