Prognostic Factors Related to the Mortality Rate of Acute-on-Chronic Liver Failure Patients

Zhang, Jian; Li, Junfeng; Chen, Yu; Ding, Mei; Duan, Zhongping

doi:10.2147/dmso.s309641

Cited by 3 publications

(1 citation statement)

References 22 publications

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“…The term CIRCI has been used since 2008 to describe disruption of the hypothalamic–pituitary–adrenal (HPA) axis during critical illness [ 22 ].…”

Section: Circi In Paediatric Age: a Challenging Diagnosismentioning

confidence: 99%

Critical illness-related corticosteroid insufficiency (CIRCI) in paediatric patients: a diagnostic and therapeutic challenge

Morabito,

Corica,

Pepe

et al. 2024

Ital J Pediatr

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Critical illness-related corticosteroid insufficiency or CIRCI is characterized by acute and life-threatening disfunction of hypothalamic–pituitary–adrenal (HPA) axis observed among intensive care unit- staying patients.It is associated with increased circulating levels of biological markers of inflammation and coagulation, morbidity, length of ICU stay, and mortality.Several mechanisms are involved in CIRCI pathogenesis: reduced CRH-stimulated ACTH release, peripheral resistance to glucocorticoids, altered cortisol synthesis, impaired cortisol-free fraction and bioavailability.Diagnostic and therapeutic management of this condition in children is still debated, probably because of the lack of agreement among intensive care specialists and endocrinologists regarding diagnostic criteria and prevalence of CIRCI in paediatric age.In the present narrative review, we focused on definition of CIRCI in paediatric age and we advise on how to diagnose and treat this poorly understood condition, based on current literature data.

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“…The term CIRCI has been used since 2008 to describe disruption of the hypothalamic–pituitary–adrenal (HPA) axis during critical illness [ 22 ].…”

Section: Circi In Paediatric Age: a Challenging Diagnosismentioning

confidence: 99%

Critical illness-related corticosteroid insufficiency (CIRCI) in paediatric patients: a diagnostic and therapeutic challenge

Morabito,

Corica,

Pepe

et al. 2024

Ital J Pediatr

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Definitions, Etiologies, and Outcomes of Acute on Chronic Liver Failure: A Systematic Review and Meta-analysis

Aggarwal,

Biswas,

Arora

et al. 2024

Clinical Gastroenterology and Hepatology

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T2-weighted imaging and dynamic contrast‑enhanced imaging in predicting the prognosis in patients with acute-on-chronic liver failure

Du,

Guan,

et al. 2023

BMC Gastroenterol

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Background Acute-on-chronic liver failure (ACLF) is a syndrome with high 28- and 90-day mortality rates. Magnetic resonance imaging (MRI) has been widely used to diagnose and evaluate liver disease. Our purpose is to determine the value of the imaging features derived from Gd-DTPA-enhanced MRI for predicting the poor outcome of patients with ACLF and develop a clinically practical radiological score. Methods This retrospective study comprised 175 ACLF patients who underwent Gd-DTPA-enhanced abdominal MRI from January 2017 to December 2021. The primary end-point was 90-day mortality. Imaging parameters, such as diffuse hyperintense of the liver on T2WI, patchy enhancement of the liver at the arterial phase, uneven enhancement of the liver at the portal vein phase, gallbladder wall edema, periportal edema, ascites, esophageal and gastric varix, umbilical vein patefac, portal vein thrombosis, and splenomegaly were screened. Cox proportional hazard regression models were used to evaluate prognostic factors and develop a prediction model. The accuracy of the model was evaluated by receiver operating characteristic (ROC) curves. Results During the follow-up period, 31 of the 175 ACLF patients died within 90 days. In the multivariate analysis, three imaging parameters were independently associated with survival: diffuse hyperintense on T2WI (p = 0.007; HR = 3.53 [1.40–8.89]), patchy enhancement at the arterial phase (p = 0.037; HR = 2.45 [1.06–5.69]), moderate ascites (vs. mild) (p = 0.006; HR = 4.12 [1.49–11.36]), and severe ascites (vs. mild) (p = 0.005; HR = 4.29 [1.57–11.71]). A practical radiological score was proposed, based on the presence of diffuse hyperintense (7 points), patchy enhancement (5 points), and ascites (6, 8, and 8 points for mild, moderate, and severe, respectively). Further analysis showed that a cut-off at 14 points was optimum to distinguish high-risk (score > 14) from the low-risk group (score ≤ 14) for 90-day survival and demonstrated a mean area under the ROC curve of 0.774 in ACLF patients. Conclusions Gd-DTPA-enhanced MR imaging features can predict poor outcomes in patients with ACLF, based on which we proposed a clinically practical radiological score allowing stratification of the 90-day survival.

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Prognostic Factors Related to the Mortality Rate of Acute-on-Chronic Liver Failure Patients

Cited by 3 publications

References 22 publications

Critical illness-related corticosteroid insufficiency (CIRCI) in paediatric patients: a diagnostic and therapeutic challenge

Critical illness-related corticosteroid insufficiency (CIRCI) in paediatric patients: a diagnostic and therapeutic challenge

Definitions, Etiologies, and Outcomes of Acute on Chronic Liver Failure: A Systematic Review and Meta-analysis

T2-weighted imaging and dynamic contrast‑enhanced imaging in predicting the prognosis in patients with acute-on-chronic liver failure

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