Alcohol and Acute-on-Chronic Liver Failure

Ballester, María Pilar; Sittner, Richard; Jalan, Rajiv

doi:10.1016/j.jceh.2021.12.010

Cited by 13 publications

(6 citation statements)

References 95 publications

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“…The development of ACLF in this case might have been due to the combination of alcoholic hepatitis and the flare of long-term occult hepatitis C infection. In patients with alcoholic hepatitis, ACLF is a frequent and severe complication, characterized by immune dysfunction and associated with an increased risk of infection [ 27 ]. We think that the flare of HCV in this patient was probably due to the dysfunction of the immune system, which is important for controlling HCV infection.…”

Section: Discussionmentioning

confidence: 99%

High-Resolution Genomic Profiling of a Genotype 3b Hepatitis C Virus from a Flare of an Occult Hepatitis Patient with Acute-on-Chronic Liver Failure

Xue

Zou

Shi

et al. 2023

Viruses

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Acute-on-chronic liver failure (ACLF) is defined as a syndrome of acutely decompensated cirrhosis in patients with chronic liver disease (CLD). Here we report an ACLF case caused by a flare of occult hepatitis C infection. This patient was infected with hepatitis C virus (HCV) more than a decade ago and hospitalized due to alcohol-associated CLD. Upon admission, the HCV RNA in the serum was negative and the anti-HCV antibody was positive, whereas the viral RNA in the plasma dramatically increased during hospitalization, which suggests an occult hepatitis C infection. Overlapped fragments encompassing the nearly whole HCV viral genome were amplified, cloned, and sequenced. Phylogenetic analysis indicated an HCV genotype 3b strain. Sanger sequencing to 10-fold coverage of the 9.4-kb nearly whole genome reveals high diversity of viral quasispecies, an indicator of chronic infection. Inherent resistance-associated substitutions (RASs) in the NS3 and NS5A but not in the NS5B regions were identified. The patient developed liver failure and accepted liver transplantation, followed by direct-acting antiviral (DAA) treatment. The hepatitis C was cured by the DAA treatment despite the existence of RASs. Thus, care should be taken for occult hepatitis C in patients with alcoholic cirrhosis. The analysis of viral genetic diversity may help to identify an occult hepatitis C virus infection and predict the efficacy of anti-viral treatment.

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Section: Discussionmentioning

confidence: 99%

High-Resolution Genomic Profiling of a Genotype 3b Hepatitis C Virus from a Flare of an Occult Hepatitis Patient with Acute-on-Chronic Liver Failure

Xue

Zou

Shi

et al. 2023

Viruses

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“…Aunque se han publicado en todo el mundo numerosas definiciones con sistemas de puntuación y pronósticos, que varían respecto a la etiología predominante y la causa de descompensación debido a la variabilidad poblacional, resaltan las definiciones realizadas por la Asociación Europea para el Estudio del Hígado (EASL), el Consorcio de América del Norte para el Estudio de la Enfermedad Hepática en Etapa Terminal (NACSELD) y la Asociación del Pacífico Asiático para el Estudio del Hígado (APASL) [6][7][8], las cuales se resumen en la tabla 1 [9]. Independiente de los criterios que se utilicen para definir ACLF, existe un consenso en todas las organizaciones internacionales sobre los precipitantes comunes, entre los cuales se destacan la infección viral, ya sea por reactivación o sobreinfección, el sangrado variceal, el consumo de alcohol, el daño hepático inducido por fármacos, la isquemia, cirugía y sepsis [10][11][12][13][14]. Además, otro punto de confluencia entre las distintas organizaciones, radica en la vía desencadenante común hacia la ACLF, que está mediada por la inflamación, provocando falla orgánica y muerte [9,11].…”

Section: Definiciónunclassified

Falla hepática aguda sobre crónica

2023

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La falla hepática aguda sobre crónica (ACLF) es un síndrome que se presenta en pacientes con cirrosis descompensada, y se caracteriza por una mortalidad elevada a 28 días, que se diagnostica con la combinación de falla hepática y extrahepática. Se han publicado numerosas definiciones, de las cuales se resalta la realizada por la Asociación Europea para el Estudio del Hígado (EASL), la cual tiene en cuenta 6 sistemas orgánicos (hígado, riñón, pulmón, cerebro, coagulación y circulación), y gradúa su gravedad basada en el número de sistemas comprometidos en el momento de la presentación. Entre los pilares en el abordaje del paciente con ACLF es imperiosa la búsqueda de los factores precipitantes, siendo los más frecuentes las infecciones bacterianas, el consumo excesivo de alcohol, la hemorragia de vías digestivas, la injuria hepática inducida por medicamentos y la cirugía hepática o cirugía mayor, teniendo en cuenta que aproximadamente en el 50 % de los casos no se logrará establecer la causa. Los pilares angulares del tratamiento constarán de la reversión o interrupción del factor precipitante, el soporte orgánico y, en aquellos pacientes que cumplan los criterios para trasplante, su realización oportuna.

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“…ACLF prognostic scores are applied to patients with severe AAH complicated by organ failure as mortality rates are similar in ACLF whether infection or AAH are incriminated. Notable prognostic scores for ACLF are: CLIF-C (European) ACLF, Asian Pacific Association for the Study of the Liver acute-on-chronic liver failure Research Consortium (AARC), North American Consortium for the Study of End-Stage Liver Disease (NACSELD)[ 41 ].…”

Section: Prognostic Scoring Systemsmentioning

confidence: 99%

Prognostic and diagnostic scoring models in acute alcohol-associated hepatitis: A review comparing the performance of different scoring systems

Mitri,

Almeqdadi,

Karagozian

2023

World J Hepatol

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Primary sclerosing cholangitis (PSC) is a chronic and progressive immune-mediated cholangiopathy causing biliary tree inflammation and scarring, leading to liver cirrhosis and end-stage liver disease. Diagnosis of PSC is challenging due to its nonspecific symptoms and overlap with other liver diseases. Despite the rising incidence of PSC, there is no proven medical therapy that can alter the natural history of the disease. While liver transplantation (LT) is the most effective approach for managing advanced liver disease caused by PSC, post-transplantation recurrence of PSC remains a challenge. Therefore, ongoing research aims to develop better therapies for PSC, and continued efforts are necessary to improve outcomes for patients with PSC. This article provides an overview of PSC’s pathogenesis, clinical presentation, and management options, including LT trends and future aspects. It also highlights the need for improved therapeutic options and ethical considerations in providing equitable access to LT for patients with PSC. Additionally, the impact of liver transplant on the quality of life and psychological outcomes of patients with PSC is discussed. Ongoing research into PSC’s pathogenesis and post-transplant recurrence is crucial for improved understanding of the disease and more effective treatment options.

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Alcohol and Acute-on-Chronic Liver Failure

Cited by 13 publications

References 95 publications

High-Resolution Genomic Profiling of a Genotype 3b Hepatitis C Virus from a Flare of an Occult Hepatitis Patient with Acute-on-Chronic Liver Failure

High-Resolution Genomic Profiling of a Genotype 3b Hepatitis C Virus from a Flare of an Occult Hepatitis Patient with Acute-on-Chronic Liver Failure

Falla hepática aguda sobre crónica

Prognostic and diagnostic scoring models in acute alcohol-associated hepatitis: A review comparing the performance of different scoring systems

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