Prediction of nosocomial acute-on-chronic liver failure in patients with cirrhosis admitted to hospital with acute decompensation

Zaccherini, Giacomo; Baldassarre, Maurizio; Bartoletti, Michele; Tufoni, Manuel; Berardi, Sonia; Tamé, Mariarosa; Napoli, Lucia; Siniscalchi, Antonio; Fabbri, Angelo; Antognoli, Agnese; Iannone, Giulia; Domenicali, Marco; Viale, Pierluigi; Trevisani, Franco; Bernardi, Mauro; Caraceni, Paolo

doi:10.1016/j.jhepr.2019.07.005

Cited by 23 publications

(18 citation statements)

References 31 publications

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“…This was a multicentre caseecontrolecontrol (1:2:2) study performed in four Italian tertiary centres over a 10-year study period (from January 2006 to December 2015). Patients were selected from prospective collected databases used for other purposes [13,14]. The study was approved by the Institutional Review Boards of participating study sites.…”

Section: Methodsmentioning

confidence: 99%

Risk factors for candidaemia in hospitalized patients with liver cirrhosis: a multicentre case–control–control study

Bartoletti

Rinaldi

Pasquini

et al. 2021

Clinical Microbiology and Infection

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The aim of this study was to evaluate the risk factors for candidaemia in patients with liver cirrhosis. Methods: This was a caseecontrolecontrol (1:2:2) study performed in four Italian tertiary centres from 2006 to 2015. Cases were patients with liver cirrhosis developing candidaemia. For every case of candidaemia we enrolled two additional patients undergoing blood cultures for suspected infection yielding isolation of a bacterial pathogen (control A) and two additional patients undergoing blood cultures for suspected infection yielding negative results (control B). Patients were matched according to age, sex and model for end stage liver disease at hospital admission. Results: During the study period 90 cases, 180 controls A and 180 controls B were included. At multivariate analysis assessed by means of multinomial conditional regression models, factors independently associated with candidaemia were previous (<30 days) acute-on-chronic liver failure (relative risk ratio (RRR) 2.22 (95% confidence interval (CI) 1.09e4.54), p ¼ 0.046), previous(<30 days) gastrointestinal endoscopy (RRR 2.38 (95% CI 1.19e4.78) p ¼ 0.014), previous(<30 days) antibiotic treatment for at least 7 days (RRR 2.74 (95% CI 1.00e7.48), p ¼ 0.049), presence of central venous catheter (RRR 2.77 (95% CI 1.26e6.09, p ¼ 0.011), total parenteral nutrition (RRR 3.90 (95% CI 1.62e9.40), p ¼ 0.002) at infection onset and length of in-hospital stay >15 days (RRR 4.63 (95% CI 2.11e10.18), p <0.001] Conversely, rifaximin treatment was associated with lower rate of candidaemia (RRR 0.38 (95% CI 0.19e0.77), p ¼ 0.007). Multivariable analysis for 30-day mortality showed that patients with isolation of Candida spp. from blood cultures had worse outcome when compared with controls even though the difference did not reach a statistical significance (hazard ratio 1.64 (95% 0.97e2.75) p ¼ 0.06). Conclusions: We identified previous antibiotic use, gastrointestinal endoscopy or acute-on-chronic liver failure and presence of central venous catheter especially for parenteral nutrition as independent factors

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Section: Methodsmentioning

confidence: 99%

Risk factors for candidaemia in hospitalized patients with liver cirrhosis: a multicentre case–control–control study

Bartoletti

Rinaldi

Pasquini

et al. 2021

Clinical Microbiology and Infection

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“…A first interesting result is that eAlb could help in predicting the occurrence of ACLF within 30 days from admission in patients hospitalized because AD. Predicting short-term occurrence of ACLF in these patients is still a not fully solved issue, even though we recently reported that different combinations of MELD, leukocyte count and blood hemoglobin thresholds could help in stratifying the risk of nosocomial ACLF [30]. What we found in this study at univariate analysis, besides confirming our previous data obtained in a different patient population and within a different time-frame [30], was that both tAlb and eAlb differed in patients with uncomplicated AD or AD complicated by the occurrence ACLF at a later time, being significantly lower in the latter.…”

Section: Accepted Articlementioning

confidence: 99%

“…Predicting short-term occurrence of ACLF in these patients is still a not fully solved issue, even though we recently reported that different combinations of MELD, leukocyte count and blood hemoglobin thresholds could help in stratifying the risk of nosocomial ACLF [30]. What we found in this study at univariate analysis, besides confirming our previous data obtained in a different patient population and within a different time-frame [30], was that both tAlb and eAlb differed in patients with uncomplicated AD or AD complicated by the occurrence ACLF at a later time, being significantly lower in the latter. Notably, eAlb, but not tAlb was an independent predictor of 30-day ACLF at a multivariable competing risk regression analysis considering in-hospital death, liver transplantation and hospital discharge as competing events.…”

Section: Accepted Articlementioning

confidence: 99%

Determination of Effective Albumin in Patients With Decompensated Cirrhosis: Clinical and Prognostic Implications

et al. 2021

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Background & Aims. Circulating albumin in cirrhosis can be dysfunctional due to accumulating structural damages, leading to the concept of effective albumin concentration (eAlb) referring to the albumin portion presenting structural and functional integrity. We aimed to estimate eAlb in patients with decompensated cirrhosis and analyze its relationships with albumin function and clinical outcomes as compared to total albumin concentration (tAlb). Approach & Results. We evaluated 319 cirrhotic patients hospitalized for acute decompensation (AD) with and without acute-on-chronic liver failure (ACLF) and 18 age-and sex-comparable outpatients with compensated cirrhosis. tAlb was quantified by standard assay, while eAlb was estimated combining liquid chromatography-electrospray ionization-mass spectrometry and standard methods. Albumin binding and detoxification efficiency were evaluated by electron paramagnetic resonance analysis. Circulating albumin in patients with decompensated cirrhosis displayed multiple structural abnormalities, with reversible oxidation and glycation being the most frequent. As a result, eAlb progressively declined with the worsening of cirrhosis, and was superior to tAlb in stratifying patients between compensated cirrhosis, AD and ACLF, as well as patients with and without complications. Moreover, eALB, but not tAlb, was closely associated with binding capacities in ACLF. Finally, eALB at admission predicted the occurrence of ACLF within 30 days and mortality at 90 days better than tAlb. Conclusion: This large observational study provides the evidence in patients with decompensated cirrhosis that eAlb can be quantified and differentiated from tAlb routinely measured in clinical practice. As compared to tAlb, eAlb is more closely associated with disease severity and albumin dysfunction, and carries a greater prognostic power. These results prompt future research assessing eAlb as a novel biomarker for predicting prognosis and treatment response.

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“…26 Furthermore, Zaccherini et al describe high leukocyte count to be an independent risk factors for developing nosocomial ACLF and associated with higher mortality in these patients. 30 The authors of the "PREDICT" study discovered that very high leukocyte count and serum CRP are associated with developing ACLF and propose inflammation to be one of the causes of ACLF. 31 Thus, our finding that elevated leukocyte count is associated with perioperative deterioration of liver function is consistent with the majority of comparable studies.…”

Section: Discussionmentioning

confidence: 99%

Surgical Procedures in Patients Awaiting Liver Transplantation: Complications and Impact on the Liver Function

Honerkamp

Sandmann

Richter

et al. 2022

Journal of Clinical and Experimental Hepatology

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Background: Potential indications for surgery frequently arise in patients awaiting liver transplantation. There is a risk of hepatic decompensation and death triggered by surgical trauma, but this has not been studied in detail in this unique population. We aimed to quantify the impact of surgical interventions in patients awaiting liver transplantation on hepatic function and identify risk factors for decompensation. Methods: All surgeries between 2000 and 2018 in patients awaiting liver transplantation in a highvolume German liver transplant center were analyzed retrospectively. Change in liver function measured as indicated by MELD score was assessed and complication rates recorded. The primary endpoint was a composite of an increase in MELD score by > 5 points or death. A logistic regression model was used for multivariate analysis to identify risk factors. Results: In total, 177 surgical procedures in 148 patients were analyzed. The primary endpoint was reached in 42 cases (23.7%). The overall in-hospital complication rate (including death) was 44.1%. Multivariate analysis identified elevated leukocyte count, perioperative blood transfusion, preoperative presence of ascites, and preoperative circulatory support as independent risk factors for a decline in liver function or death. Conclusion: Surgery in patients awaiting liver transplantation carries a relevant risk of hepatic decompensation and death that needs to be considered when deciding whether to perform elective surgery prior to or defer until after liver transplantation.

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Prediction of nosocomial acute-on-chronic liver failure in patients with cirrhosis admitted to hospital with acute decompensation

Cited by 23 publications

References 31 publications

Risk factors for candidaemia in hospitalized patients with liver cirrhosis: a multicentre case–control–control study

Risk factors for candidaemia in hospitalized patients with liver cirrhosis: a multicentre case–control–control study

Determination of Effective Albumin in Patients With Decompensated Cirrhosis: Clinical and Prognostic Implications

Surgical Procedures in Patients Awaiting Liver Transplantation: Complications and Impact on the Liver Function

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