Acute-on-Chronic Liver Failure Is Independently Associated With Lower Survival in Patients With Spontaneous Bacterial Peritonitis

Jacques, Raquel de Oliveira Coberllini; Massignan, L; Winkler, Martina; Balbinot, Rafael Sartori; Balbinot, Raul Angelo; Soldera, Jonathan

doi:10.1590/s0004-2803.202100000-58

Cited by 9 publications

(4 citation statements)

References 62 publications

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“…The use of EASL-CLIF criteria on ACLF and CLIF-SOFA for prognostication of sepsis in cirrhotic patients admitted to the ICU has gained significant attention[ 8 , 38 ]. These scoring systems have been developed to assess the severity of liver disease and predict mortality in severely decompensated cirrhosis patients[ 39 - 42 ]. By incorporating organ failure parameters, such as cardiovascular, renal, respiratory, neurological, hematological, and hepatic dysfunction, these criteria provide a comprehensive evaluation of the patient's condition.…”

Section: Discussionmentioning

confidence: 99%

Management of sepsis in a cirrhotic patient admitted to the intensive care unit: A systematic literature review

Ndomba,

Soldera

2023

World J Hepatol

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BACKGROUND Sepsis is a severe medical condition that occurs when the body's immune system overreacts to an infection, leading to life-threatening organ dysfunction. The "Third international consensus definitions for sepsis and septic shock (Sepsis-3)" defines sepsis as an increase in sequential organ failure assessment score of 2 points or more, with a mortality rate above 10%. Sepsis is a leading cause of intensive care unit (ICU) admissions, and patients with underlying conditions such as cirrhosis have a higher risk of poor outcomes. Therefore, it is critical to recognize and manage sepsis promptly by administering fluids, vasopressors, steroids, and antibiotics, and identifying and treating the source of infection. AIM To conduct a systematic review and meta-analysis of existing literature on the management of sepsis in cirrhotic patients admitted to the ICU and compare the management of sepsis between cirrhotic and non-cirrhotic patients in the ICU. METHODS This study is a systematic literature review that followed the PRISMA statement's standardized search method. The search for relevant studies was conducted across multiple databases, including PubMed, Embase, Base, and Cochrane, using predefined search terms. One reviewer conducted the initial search, and the eligibility criteria were applied to the titles and abstracts of the retrieved articles. The selected articles were then evaluated based on the research objectives to ensure relevance to the study's aims. RESULTS The study findings indicate that cirrhotic patients are more susceptible to infections, resulting in higher mortality rates ranging from 18% to 60%. Early identification of the infection source followed by timely administration of antibiotics, vasopressors, and corticosteroids has been shown to improve patient outcomes. Procalcitonin is a useful biomarker for diagnosing infections in cirrhotic patients. Moreover, presepsin and resistin have been found to be reliable markers of bacterial infection in patients with decompensated liver cirrhosis, with similar diagnostic performance compared to procalcitonin. CONCLUSION This review highlights the importance of early detection and management of infections in cirrhosis patients to reduce mortality. Therefore, early detection of infection using procalcitonin test and other biomarker as presepsin and resistin, associated with early management with antibiotics, fluids, vasopressors and low dose corticosteroids might reduce the mortality associated with sepsis in cirrhotic patients.

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Section: Discussionmentioning

confidence: 99%

Management of sepsis in a cirrhotic patient admitted to the intensive care unit: A systematic literature review

Ndomba,

Soldera

2023

World J Hepatol

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“…For patients with ACLF and AEVH, 30-day mortality was 67.5%, considerably higher than the 33.9% described in the CANONIC study[ 19 ] and the 39% described in other studies[ 40 - 42 ]. For patients with ACLF diagnosed with Spontaneous Bacterial peritonitis, a 28-day-mortality of 65% has been described[ 43 , 44 ], while a 30-day mortality of 67.3% has been described for HRS patients[ 32 , 45 ].…”

Section: Discussionmentioning

confidence: 99%

Acute-on-chronic liver failure is independently associated with higher mortality for cirrhotic patients with acute esophageal variceal hemorrhage: Retrospective cohort study

Terres¹,

Balbinot²,

Muscope³

et al. 2023

World J Clin Cases

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BACKGROUND Acute esophageal variceal hemorrhage (AEVH) is a common complication of cirrhosis and might precipitate multi-organ failure, causing acute-on-chronic liver failure (ACLF). AIM To analyze if the presence and grading of ACLF as defined by European Society for the Study of the Liver-Chronic Liver Failure (EASL-CLIF) is able to predict mortality in cirrhotic patients presenting AEVH. METHODS Retrospective cohort study executed in Hospital Geral de Caxias do Sul. Data from medical records from 2010 to 2016 were obtained by searching the hospital electronic database for patients who received terlipressin. Medical records were reviewed in order to determine the diagnosis of cirrhosis and AEVH, including 97 patients. Kaplan-Meier survival analysis was used for univariate analysis and a stepwise approach to the Cox regression for multivariate analysis. RESULTS All- cause mortality for AEVH patients was 36%, 40.2% and 49.4% for 30-, 90- and 365-day, respectively. The prevalence of ACLF was 41.3%. Of these, 35% grade 1, 50% grade 2 and 15% grade 3. In multivariate analysis, the non-use of non-selective beta-blockers, presence and higher grading of ACLF and higher Model for End-Stage Liver Disease scores were independently associated with higher mortality for 30-day with the addition of higher Child-Pugh scores for 90-day period. CONCLUSION Presence and grading of ACLF according to the EASL-CLIF criteria was independently associated with higher 30- and 90-day mortality in cirrhotic patients admitted due to AEVH.

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“…However, inferior per formance of CLIF-ACLF compared to CLIF-SOFA has been reported[ 34 ]. Results of CLIF-SOFA, CLIF-C[ 36 - 39 ] and ACLF classification[ 40 - 43 ] has been conflicting[ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…RF employs parallel ensembling, training multiple decision tree classifiers on different data subsets and combining their outcomes through averaging or majority voting. This approach effectively addresses overfitting concerns and enhances prediction accuracy, making it suitable for both continuous and categorical data in classification and regression problems[ 40 ].…”

Section: Introductionmentioning

confidence: 99%

Use of machine learning models for the prognostication of liver transplantation: A systematic review

Chongo,

Soldera

2024

World J Transplant

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BACKGROUND Liver transplantation (LT) is a life-saving intervention for patients with end-stage liver disease. However, the equitable allocation of scarce donor organs remains a formidable challenge. Prognostic tools are pivotal in identifying the most suitable transplant candidates. Traditionally, scoring systems like the model for end-stage liver disease have been instrumental in this process. Nevertheless, the landscape of prognostication is undergoing a transformation with the integration of machine learning (ML) and artificial intelligence models. AIM To assess the utility of ML models in prognostication for LT, comparing their performance and reliability to established traditional scoring systems. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we conducted a thorough and standardized literature search using the PubMed/MEDLINE database. Our search imposed no restrictions on publication year, age, or gender. Exclusion criteria encompassed non-English studies, review articles, case reports, conference papers, studies with missing data, or those exhibiting evident methodological flaws. RESULTS Our search yielded a total of 64 articles, with 23 meeting the inclusion criteria. Among the selected studies, 60.8% originated from the United States and China combined. Only one pediatric study met the criteria. Notably, 91% of the studies were published within the past five years. ML models consistently demonstrated satisfactory to excellent area under the receiver operating characteristic curve values (ranging from 0.6 to 1) across all studies, surpassing the performance of traditional scoring systems. Random forest exhibited superior predictive capabilities for 90-d mortality following LT, sepsis, and acute kidney injury (AKI). In contrast, gradient boosting excelled in predicting the risk of graft-versus-host disease, pneumonia, and AKI. CONCLUSION This study underscores the potential of ML models in guiding decisions related to allograft allocation and LT, marking a significant evolution in the field of prognostication.

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Acute-on-Chronic Liver Failure Is Independently Associated With Lower Survival in Patients With Spontaneous Bacterial Peritonitis

Cited by 9 publications

References 62 publications

Management of sepsis in a cirrhotic patient admitted to the intensive care unit: A systematic literature review

Management of sepsis in a cirrhotic patient admitted to the intensive care unit: A systematic literature review

Acute-on-chronic liver failure is independently associated with higher mortality for cirrhotic patients with acute esophageal variceal hemorrhage: Retrospective cohort study

Use of machine learning models for the prognostication of liver transplantation: A systematic review

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