Evidence-based protocol for diagnosis and treatment of hepatorenal syndrome is independently associated with lower mortality

Terres, Alana Zulian; Balbinot, Rafael Sartori; Muscope, Ana Laura Facco; Longen, Morgana Luisa; Schena, Bruna; Cini, Bruna Teston; Rost, Gilberto Luis; Balensiefer, Juline Isabel Leichtweis; Eberhardt, Louise Zanotto; Balbinot, Raul Angelo; Soldera, Jonathan

doi:10.1016/j.gastrohep.2021.02.007

Cited by 14 publications

(8 citation statements)

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“…The management of sepsis in cirrhosis patients requires early detection and intervention with antibiotics, fluid resuscitation, vasopressors, and corticosteroids. While current management strategies are similar to those recommended in the SSC international guideline[ 36 ], studies have shown that the use of human albumin and norepinephrine or combination therapy with terlipressin and norepinephrine may be more effective. Choudhury et al [ 35 ] found that terlipressin is as effective as noradrenaline in increasing the MAP of more than 65 mmHg at 6 h and 48 h, and has a potential role in treating and preventing variceal bleeding as well as acute kidney injury[ 36 ].…”

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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“…Terres et al [ 39 ] assessed and compared the significance of liver-specific scores in predicting mortality in hepatorenal syndrome (HRS) patients who received terlipressin. CTP was superior to CLIF-SOFA, CLIF-ACLF, MELD, and MELD-Na in estimating 30-d, 90-d, and 365-d mortality[ 39 ].…”

Section: Discussionmentioning

confidence: 99%

CLIF-SOFA and CLIF-C scores for the prognostication of acute-on-chronic liver failure and acute decompensation of cirrhosis: A systematic review

Rashed¹,

Soldera²

2022

World J Hepatol

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BACKGROUND Acute-on-chronic liver failure (ACLF) is a syndrome characterized by decompensation in individuals with chronic liver disease, generally secondary to one or more extra-hepatic organ failures, implying an elevated mortality rate. Acute decompensation (AD) is the term used for one or more significant consequences of liver disease in a short time and is the most common reason for hospital admission in cirrhotic patients. The European Association for the Study of Liver-Chronic-Liver Failure (EASL-CLIF) Group modified the intensive care Sequential Organ Failure Assessment score into CLIF-SOFA, which detects the presence of ACLF in patients with or without AD, classifying it into three grades . AIM To investigate the role of the EASL-CLIF definition for ACLF and the ability of CLIF-SOFA, CLIF-C ACLF, and CLIF-C AD scores for prognosticating ACLF or AD. METHODS This study is a literature review using a standardized search method, conducted using the steps following the guidelines for reporting systematic reviews set out by the PRISMA statement. For specific keywords, relevant articles were found by searching PubMed, ScienceDirect, and BioMed Central-BMC. The databases were searched using the search terms by one reviewer, and a list of potentially eligible studies was generated based on the titles and abstracts screened. The data were then extracted and assessed on the basis of the Reference Citation Analysis ( ). RESULTS Most of the included studies used the EASL-CLIF definition for ACLF to identify cirrhotic patients with a significant risk of short-term mortality. The primary outcome in all reviewed studies was mortality. Most of the study findings were based on an area under the receiver operating characteristic curve (AUROC) analysis, which revealed that CLIF-SOFA, CLIF-C ACLF, and CLIF-C AD scores were preferable to other models predicting 28-d mortality. Their AUROC scores were higher and able to predict all-cause mortality at 90, 180, and 365 d. A total of 50 articles were included in this study, which found that the CLIF-SOFA, CLIF-C ACLF and CLIF-C AD scores in more than half of the articles were able to predict short-term and long-term mortality in patients with either ACLF or AD. CONCLUSION CLIF-SOFA score surpasses other models in predicting mortality in ACLF patients, especially in the short-term. CLIF-SOFA, CLIF-C ACLF, and CLIF-C AD are accurate short-term and long-term mortality prognosticating scores.

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“…Standardized imaging criteria were used for the diagnosis of hepatocellular carcinoma (23) . Previously published clinical criteria were used for the diagnosis of Hepatorenal Syndrome type 1, published in 2007 (24,25) :…”

Section: Variablesmentioning

confidence: 99%

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

Jacques

Massignan

Winkler

et al. 2021

Arq. Gastroenterol.

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BACKGROUND: Spontaneous bacterial peritonitis (SBP) is a decompensation of cirrhosis with an in-hospital mortality ranging from 20% to 40%. OBJECTIVE: The purpose of this study is to analyze if EASL-CLIF definition of acute-on-chronic liver failure (ACLF) is able to predict mortality in cirrhotic patients with SBP. METHODS: Historical cohort study conducted in a public tertiary care teaching hospital. Data from medical records from January 2009 to July 2016 were obtained by searching the hospital electronic database for samples of ascites collected in the period. Electronic and physical medical records were analyzed and patients were included if they were over 18-years old, with cirrhosis and an ascites fluid compatible with SBP: 69 patients were included. Liver-specific scores were calculated and Kaplan-Meier survival analysis was used for univariate analysis and a stepwise approach to the Cox regression for multivariate analysis. RESULTS: All cause mortality was 44%, 56.5% and 74% for 28-, 90- and 365-day, respectively. The prevalence of ACLF was 58%. Of these, 65% grade 1, 17.5% grade 2 and 17.5% grade 3. In multivariate analysis, the use of proton-pump inhibitors, alanine transaminase lower than 40 U/L, hemoglobin higher than 9 g/dL, absence of ACLF and lower CLIF-SOFA and MELD scores were independently associated with higher survival for both 28- and 90-day interval. CONCLUSION: The presence of ACLF and higher CLIF-SOFA scores were independently associated with higher 28- and 90-day mortality in cirrhotic patients admitted due to SBP.

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Evidence-based protocol for diagnosis and treatment of hepatorenal syndrome is independently associated with lower mortality

Cited by 14 publications

References 70 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

CLIF-SOFA and CLIF-C scores for the prognostication of acute-on-chronic liver failure and acute decompensation of cirrhosis: A systematic review

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

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