Original ResearchFull Report: Clinical—LiverAcute-on-Chronic Liver Failure Is a Distinct Syndrome That Develops in Patients With Acute Decompensation of Cirrhosis
Section snippets
Study Design
Patients were screened and enrolled from February to September 2011 in 12 European countries after the appropriate approvals were obtained. Patients were screened at liver units in 29 university hospitals; each liver unit had a regular ward, intensive care facilities, and a liver transplantation program. The policy of allocation of liver transplants was similar among study centers. The diagnosis of cirrhosis was based on previous liver biopsy findings or a composite of clinical signs and
Patients
A total of 2149 consecutive patients were screened, of whom 1343 were enrolled. A majority of patients were enrolled during the first 4 days after hospital admission (Supplementary Figure 1). In total, 817 (60.8%), 1004 (74.8%), and 1185 (88.2%) patients were enrolled 1, 2, and 4 days after hospital admission, respectively. In 158 patients (11.7%), the elapsed time between hospital admission and enrollment was more than 4 days. Reasons for the delay between hospital admission and study
Discussion
The aim of the current study was to establish the diagnostic criteria of ACLF and subsequently to assess the natural history of this syndrome. There was no “evidence-based” definition of ACLF at the time of this study, so we had to assume several important issues. First, the study was performed in patients with AD because this is an essential component of the syndrome. Here, we assumed that organ failure detected at study enrollment developed simultaneously with AD and not before. This
Acknowledgments
The authors thank the nursing staff in the units of each center for their excellent support, the patients for their participation in the study, and Nicki van Berckel for administrative support.
References (30)
- et al.
The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club
Hepatology
(2003) - et al.
Hepatic encephalopathy
Am J Gastroenterol
(2001) - et al.
Acute-on-chronic liver failure
J Hepatol
(2012) - et al.
Clinical profile and predictors of mortality in patients of acute-on-chronic liver failure
Dig Liver Dis
(2012) - et al.
Short-term prognosis in critically ill patients with cirrhosis assessed by prognostic scoring systems
Hepatology
(2001) - et al.
Prospective evaluation of the prognostic scores for cirrhotic patients admitted to an intensive care unit
J Hepatol
(2012) - et al.
Acute renal failure in patients with cirrhosis: perspectives in the age of MELD
Hepatology
(2003) - et al.
Model for end-stage liver disease (MELD) and allocation of donor livers
Gastroenterology
(2003) - et al.
Comparison of the SpO2/FIO2 ratio and the PaO2/FIO2 ratio in patients with acute lung injury or ARDS
Chest
(2007) - et al.
Management of varices and variceal hemorrhage in cirrhosis
N Engl J Med
(2010)
Infections in patients with cirrhosis increase mortality four-fold and should be used in determining prognosis
Gastroenterology
Severe sepsis in cirrhosis
Hepatology
Acute-on-chronic liver failure: pathophysiological basis of therapeutic options
Blood Purif
Acute-on-chronic liver failure: concept, natural history, and prognosis
Curr Opin Crit Care
Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL)
Hepatol Int
Cited by (2201)
Comparison of a Novel Score “NOD−ACLF” to Other Established Prognostic Scores for Prediction of Mortality in APASL−ACLF Patients: A Cohort Study from a Tertiary Care Center of North India
2024, Journal of Clinical and Experimental HepatologyExploring the Prevalence, Predictors, and Impact of Bacterial Infections to Guide Empiric Antimicrobial Decisions in Cirrhosis (EPIC-AD)
2024, Journal of Clinical and Experimental HepatologyThe Story of Ammonia in Liver Disease: An Unraveling Continuum
2024, Journal of Clinical and Experimental HepatologyContinuous renal replacement therapy and survival in acute liver failure: A systematic review and meta-analysis
2024, Journal of Critical CareHigh Mortality With Non-O1/Non-O139 Vibrio cholera Bacteraemia in Patients With Cirrhosis
2024, Journal of Clinical and Experimental HepatologyLiver Transplantation in Chronic Liver Disease and Acute on Chronic Liver Failure- Indication, Timing and Practices
2024, Journal of Clinical and Experimental Hepatology
A list of CANONIC study investigators is provided in the Appendix.
Conflicts of interest The authors disclose the following: This is the first result of an initiative of several European and American investigators to potentiate research in chronic liver failure (CLIF). An assembly of European hepatologists proposed the European Association for the Study of the Liver (EASL) to endorse a consortium aimed to promote research on CLIF, to stimulate the formation of research groups in this field in Europe, and to identify potential areas of common interest with European industry. The Executive Committee of EASL accepted to endorse the consortium on June 2009 and elected V.A. and M.B. as chairman and vice-chairman, respectively, for 5 years. Twelve other EASL members proposed by the assembly were elected to form the Steering Committee. From 2009 to 2012, the EASL-CLIF Consortium received unrestricted grants from Grifols and Gambro. Grifols has prolonged its unrestricted grant for an additional 4 years. There is no other support for the consortium. The Fundació Clinic, a foundation ruled by the Hospital Clinic and University of Barcelona, administers the EASL-CLIF Consortium grants. V.A., M.B., and members of the Steering Committee have no relationship with Grifols or Gambro other than conferences in international meetings (from which they may receive an honorarium) or as investigators on specific projects unrelated to the consortium. Until now the EASL-CLIF Consortium has not performed any study promoted by pharmaceutical companies. The scientific agenda of the EASL-CLIF Consortium and the specific research protocols are made exclusively by the Steering Committee members without any participation of pharmaceutical companies. R.J. received research funding from Vital Therapies, has served on a scientific advisory board for Conatus Pharma, and received lecture fees from Gambro. P.G. has received speaker honorarium and research funding from Grifols, served on the scientific advisory board for Ferring and Sequana, and received research funding from Sequana. J.C. has served as a consultant to Ocera. A.G. has served as a consultant to CSL Behring. S.Z. has served as a consultant to Abbott, Achillion, AstraZeneca, Bristol Myers-Squibb, Boehringer Ingelheim, Gilead, Janssen Cilag, Merck, Novartis, Presidio, Roche, Santaris, and Vertex. V.A. has received grant and research support from Grifols. The remaining authors disclose no conflicts.
Funding The CLIF Consortium is supported by an unrestricted grant from Grifols. R.M. was supported by an INSERM-APHP fellowship and J.T. by grants from the Deutsche Forschungsgemeinschaft (SFB TRR57 project 18).