The Clinical Spectrum and Manifestations of Acute-on-Chronic Liver Failure
Acute-on-chronic liver failure (ACLF) is characterized by abrupt decompensation in a patient with chronic liver disease with extrahepatic organ dysfunction and is implicated in an increased risk of mortality. ACLF may be present in approximately 20% to 40% of hospitalized cirrhosis. There are several diagnostic scoring systems for ACLF; one defined by the North American Consortium for Study of End-stage Liver Disease is the presence of acutely decompensated cirrhosis complicated by failure of two or more organ systems: circulatory, renal, neurological, coagulopathy, and/or pulmonary. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - April 23, 2023 Category: Gastroenterology Authors: Andrew R. Scheinberg, Paul Martin, Kalyan Ram Bhamidimarri Source Type: research
Prognostic Models in Acute-on-Chronic Liver Failure
Acute-on-chronic liver failure (ACLF) is a clinical syndrome characterized by severe hepatic dysfunction leading to multiorgan failure in patients with end-stage liver disease. ACLF is a challenging clinical syndrome with a rapid clinical course and high short-term mortality. There is no single uniform definition of ACLF or consensus in predicting ACLF-related outcomes, which makes comparing studies difficult and standardizing management protocols challenging. This review aims to provide insights into the common prognostic models that define and grade ACLF. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - April 23, 2023 Category: Gastroenterology Authors: Daniela Goyes, Hirsh D. Trivedi, Michael P. Curry Source Type: research
Bacterial Infections in Acute on Chronic Liver Failure
Bacterial infections (BIs) are the most common precipitating event of acute-on-chronic liver failure (ACLF) and a frequent complication of ACLF. BIs aggravate the course of the syndrome and are associated with higher mortality rates. For this reason, BIs should be promptly diagnosed and treated in all patients with ACLF. The administration of an appropriate empirical antibiotic therapy improves survival in patients with BIs and ACLF and is the cornerstone of treatment. Due to the spread of antibiotic resistance worldwide, the empirical treatment should cover multi-drug-resistant organisms. Herein we reviewed the current ev...
Source: Clinics in Liver Disease - April 23, 2023 Category: Gastroenterology Authors: Simone Incicco, Paolo Angeli, Salvatore Piano Source Type: research
Liver Transplantation in Acute-on-Chronic Liver Failure
In recent years there has been a significant increase in the incidence of acute-on-chronic liver failure (ACLF). This syndrome is characterized by infections, organ failures, and high short-term mortality. Although progress in the management of these sick patients has been evident, liver transplantation (LT) remains the best treatment modality to date. Several studies have reported LT as a feasible option, despite organ failures. The outcomes following LT are inversely related to the grade of ACLF. This review discusses the current literature on the feasibility, futility, timing, and outcomes of LT in patients with ACLF. (...
Source: Clinics in Liver Disease - April 23, 2023 Category: Gastroenterology Authors: Anand V. Kulkarni, K. Rajender Reddy Source Type: research
Preface
Acute on chronic liver failure (ACLF) is a syndrome defined as rapid decompensation of liver function and organ failure on a patient suffering from chronic liver disease with potentially lethal complications. Managing a patient with ACLF is extremely challenging requiring a “team approach” composed by an army of highly specialized and dedicated clinicians and researchers. We are excited, as several causes inducing liver disease can now be controlled, viral in particular, but the way we treat late stages of ACLF still remains the same: Liver Transplantation. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - April 6, 2023 Category: Gastroenterology Authors: Nikolaos Pyrsopoulos Source Type: research
Physicians' Use of Digital Health Interventions in the Management of Nonalcoholic Fatty Liver Disease
Globally, the use of digital health interventions (DHIs) is expanding, along with growing scientific evidence of their effectiveness. Given the high and increasing prevalence of noncommunicable liver disease, we surveyed 295 physicians across Spain about their knowledge, beliefs, attitudes, practices, and access with regard to DHIs for patient care and in particular for liver diseases, including nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Physicians reported high familiarity with DHIs, although most had not recommended them in patient care. Addressing concerns, including limited available time, evide...
Source: Clinics in Liver Disease - April 5, 2023 Category: Gastroenterology Authors: Jeffrey V. Lazarus, Marcela Villota-Rivas, Carolina Jim énez-González, Alvaro Santos-Laso, Paula Iruzubieta, María Teresa Arias-Loste, Lisa Rice-Duek, Simon Leigh, Christopher J. Kopka, Juan Turnes, José Luis Calleja, Javier Crespo Source Type: research
Update on Non-Alcoholic Steatohepatitis
CLINICS IN LIVER DISEASE (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - April 5, 2023 Category: Gastroenterology Authors: Zobair M. Younossi Source Type: research
Copyright
Elsevier (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - April 5, 2023 Category: Gastroenterology Source Type: research
Contributors
NORMAN GITLIN, MD, FRCP (LONDON), FRCPE (EDINBURGH), FAASLD, FACP, FACG (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - April 5, 2023 Category: Gastroenterology Source Type: research
Contents
Zobair M. Younossi (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - April 5, 2023 Category: Gastroenterology Source Type: research
Forthcoming Issues
Acute-on-Chronic Liver Failure (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - April 5, 2023 Category: Gastroenterology Source Type: research
Hepatic Outcomes of Nonalcoholic Fatty Liver Disease Including Cirrhosis and Hepatocellular Carcinoma
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide and represents a significant cause of cirrhosis and hepatocellular carcinoma (HCC). Almost 20% of patients with NAFLD and advanced fibrosis develop cirrhosis, of which 20% can progress to decompensated liver stage. Although patients with cirrhosis or fibrosis continue to have a high risk for HCC progression, growing evidence shows that NAFLD-HCC can develop even in the absence of cirrhosis. Current evidence characterizes NAFLD-HCC primarily as a condition with late presentation, lower response to curative therapy, and poor prognosis...
Source: Clinics in Liver Disease - March 9, 2023 Category: Gastroenterology Authors: Saleh A. Alqahtani, Wah-Kheong Chan, Ming-Lung Yu Source Type: research
Roles of Radiological Tests in Clinical Trials and the Clinical Management of Nonalcoholic Fatty Liver Disease
Radiological testing is now routinely used for clinical trial prescreening, diagnosis, and treatment and referral. The CAP performs well in detecting fatty liver but is unable to grade and track longitudinal changes. MRI-PDFF is a better technique for evaluating longitudinal changes and is used as a primary endpoint in trials of antisteatotic agents. The probability of detecting liver fibrosis using radiological testing techniques is high when performed at referral centers, and reasonable imaging strategies include the combination of FIB-4 and VCTE, the FAST Score, MAST, and MEFIB. The strategy currently recommended is the...
Source: Clinics in Liver Disease - March 9, 2023 Category: Gastroenterology Authors: Winston Dunn, Laurent Castera, Rohit Loomba Source Type: research
Preface
Epidemiologic data published in 2023 suggest that nonalcoholic fatty liver (NAFLD) and nonalcoholic steatohepatitis (NASH) affect around 30% and 5% of the world population and is on track to become the most common cause of cirrhosis and hepatocellular carcinoma (HCC), the most common cause for liver death, and the most common indication for liver transplantation. Driven by the global pandemic of obesity and type 2 diabetes, the global burden of NAFLD can be measured not only in clinical terms (liver mortality, cirrhosis, HCC) but also by its negative impact on patient-reported outcomes and the economic burden of the diseas...
Source: Clinics in Liver Disease - March 9, 2023 Category: Gastroenterology Authors: Zobair M. Younossi Source Type: research
Genetic Markers Predisposing to Nonalcoholic Steatohepatitis
The growing prevalence of nonalcoholic fatty liver disease (NAFLD) has sparked interest in understanding genetics and epigenetics associated with the development and progression of the disease. A better understanding of the genetic factors related to progression will be beneficial in the risk stratification of patients. These genetic markers can also serve as potential therapeutic targets in the future. In this review, we focus on the genetic markers associated with the progression and severity of NAFLD. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - March 8, 2023 Category: Gastroenterology Authors: Aalam Sohal, Hunza Chaudhry, Kris V. Kowdley Source Type: research
