Association Between Grade of Acute on Chronic Liver Failure and Response to Terlipressin and Albumin in Patients With Hepatorenal Syndrome

Piano, Salvatore; Schmidt, Hartmut; Ariza, Xavier; Amorós, Àlex; Romano, A.; Hüsing‐Kabar, Anna; Solà, Elsa; Gerbes, Alexander L.; Bernardi, Mauro; Alessandria, Carlo; Scheiner, Bernhard; Tonon, Marta; Maschmeier, Miriam; Solé, Cristina; Trebicka, Jonel; Gustot, Thierry; Nevens, Frederik; Arroyo, Vicente; Ginès, Pere; Angeli, Paolo

doi:10.1016/j.cgh.2018.01.035

Cited by 150 publications

(129 citation statements)

References 22 publications

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“…However, HRS is not completely preventable by antibiotics, nor can we reverse HRS associated with infection by treatment of infection alone . Even with regimens including supportive care and HRS‐directed therapies such as terlipressin and intravenous albumin, there is an increased HRS treatment‐failure rate at higher ACLF grades . Therapies focusing on new pathways around an elevated inflammatory state may improve outcomes of these critically ill patients.…”

Section: Discussionmentioning

confidence: 99%

Serum Angiopoietin‐2 Predicts Mortality and Kidney Outcomes in Decompensated Cirrhosis

et al. 2019

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Section: Discussionmentioning

confidence: 99%

Serum Angiopoietin‐2 Predicts Mortality and Kidney Outcomes in Decompensated Cirrhosis

et al. 2019

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“…Recent data show that beside SCr values, the presence and the severity of ACLF have also an important impact on treatment response. Patients with grade 3 ACLF (the most severe stage of ACLF) have significantly lower probability of response to treatment compared to patients with ACLF grade 1 or 2 (29% in ACLF‐3, compared to 60% and 48% in ACLF‐1 and ACLF‐2 respectively; P < .001) …”

Section: Management Of Hepatorenal Syndrome‐akimentioning

confidence: 99%

Hepatorenal syndrome in the era of acute kidney injury

Solé

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Solà

et al. 2018

Liver International

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Acute kidney injury (AKI) is a frequent complication of patients with advanced cirrhosis that it is associated with increased hospital admissions and decreased survival. The definition of AKI in cirrhosis has been recently modified and the new diagnostic criteria are based on small changes in serum creatinine with respect to previous values, occurring within a short period of time. The use of this new definition may lead to an earlier identification of renal impairment and better prognostic stratification. Hepatorenal syndrome (HRS) is a unique form of AKI developing in patients with end-stage liver disease. Systemic circulatory dysfunction and marked kidney vasoconstriction play a key role in the development of HRS. The modification of the definition of AKI has also led to a change in the diagnostic criteria of HRS. The new diagnostic criteria are based on AKI stages and there is no need to reach a specific serum creatinine threshold. According to these new criteria, treatment with vasoconstrictors and albumin for the management of HRS will be started at lower serum creatinine values, with expected higher response rates. Finally, there are consistent data showing that some urine biomarkers, particularly NGAL (neutrophil gelatinase-associated lipocalin), may be useful in daily clinical practice for the differential diagnosis of the cause of AKI in cirrhosis.

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“…While albumin treatment has been used in different clinical situations for years, the patient benefit remains under discussion. In a small number of scenarios, a clear benefit can be noted, such as in HRS, which basically is a functional renal failure in cirrhosis, in the prevention of HRS when SBP is present, and in the prevention of post-paracentesisinduced circulatory dysfunction [59,69]. These scenarios require more or less infusion of HA.…”

Section: Albumin As Attenuation Of Inflammationmentioning

confidence: 99%

Gut-Liver Axis Links Portal Hypertension to Acute-on-Chronic Liver Failure

2018

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Acute-on-chronic liver failure (ACLF) is considered a distinct syndrome in patients with liver disease, with systemic inflammation playing a central role. Portal hypertension (PHT) is also aggravated by inflammation and may subsequently impact the course of ACLF. PHT is more than just an increase in portal pressure in the portal venous system; it aggravates the course of liver disease and, thus, also facilitates the development of acute decompensation and ACLF. A critical mechanistic link between PHT and ACLF might be the gut-liver axis, which is discussed in this review.

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Association Between Grade of Acute on Chronic Liver Failure and Response to Terlipressin and Albumin in Patients With Hepatorenal Syndrome

Cited by 150 publications

References 22 publications

Serum Angiopoietin‐2 Predicts Mortality and Kidney Outcomes in Decompensated Cirrhosis

Serum Angiopoietin‐2 Predicts Mortality and Kidney Outcomes in Decompensated Cirrhosis

Hepatorenal syndrome in the era of acute kidney injury

Gut-Liver Axis Links Portal Hypertension to Acute-on-Chronic Liver Failure

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