Journal ArticleDOI
Plasma perfusion combined with plasma exchange in chronic hepatitis B-related acute-on-chronic liver failure patients
Zhongyuan Yang,Zhongwei Zhang,Qiuyu Cheng,Guang Chen,Weina Li,Ke Ma,Wei Guo,Xiaoping Luo,Tao Chen,Qin Ning +9 more
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TLDR
Evaluating the effectiveness of plasma perfusion combined with plasma exchange in patients with hepatitis B virus-related ACLF found PP’+ PE treatment significantly reversed organ failures and ameliorated the development of new organ failure and complications, thus reducing mortality risk of patients with HBV-ACLF.Abstract:
Artificial liver support systems (ALSS) have been shown to significantly reduce mortality in patients with acute-on-chronic liver failure (ACLF). However, the characteristics of patients who would benefit most from ALSS treatment are poorly understood. This study aimed to delineate the indicators for ALSS and evaluate the effectiveness of plasma perfusion combined with plasma exchange (PP + PE) in patients with hepatitis B virus-related ACLF (HBV-ACLF). A total of 898 patients with HBV-ACLF in a single center were enrolled retrospectively. Propensity score matching (PSM) was used in case-paired analysis. Hepatic or extra-hepatic organ failures were defined by Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA) criteria. Complications included ascites, infection, hepatopulmonary syndrome, hepatorenal syndrome, hepatic encephalopathy and upper gastrointestinal bleeding. Numbers of organ failures or complications were used for risk stratification. Among all patients, 418 patients received standard medical therapy (SMT) and 480 received PP + PE plus SMT. After one-to-one paired PSM within the two groups without risk stratification, 293 pairs were enrolled. The PP + PE group displayed significantly lower mortality risk in both 28- and 90-day observation durations. When stratified, patients with two or more organ failures or complications from the PP + PE group showed greater decrease in mortality risk. Moreover, PP + PE treatment significantly increased the resolution of organ failures and complications and ameliorated the development of new organ failures and complications. PP + PE treatment significantly reversed organ failures and ameliorated the development of new organ failures and complications, thus reducing mortality risk of patients with HBV-ACLF.read more
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Journal ArticleDOI
Leukocytes, Systemic Inflammation and Immunopathology in Acute-on-Chronic Liver Failure.
TL;DR: The prevailing characteristics of the hyperinflammatory state in patients with acutely decompensated cirrhosis developing ACLF are described, with special emphasis on cells of the innate immune system, their triggers, their effector molecules and the consequences on tissue immunopathology.
Journal ArticleDOI
Low Volume Plasma Exchange and Low Dose Steroid Improve Survival in Patients With Alcohol-Related Acute on Chronic Liver Failure and Severe Alcoholic Hepatitis – Preliminary Experience
Santhosh E. Kumar,Ashish Goel,Uday Zachariah,Sukesh C. Nair,Vinoi George David,Santosh Varughese,Prashanth B. Gandhi,Amit Barpha,Anand Sharma,Balakrishnan Vijayalekshmi,Kunissery A. Balasubramanian,Elwyn Elias,Chundamannil E. Eapen +12 more
TL;DR: Compared to SMT, low volume PLEX and low dose steroid improved survival over one year in A-ACLF patients with severe alcoholic hepatitis, and in patients with renal dysfunction, 60% showed improvement in renal function with PLEx.
Journal ArticleDOI
Low Volume Plasma Exchange and Low Dose Steroid Improve Survival in Patients With Alcohol-Related Acute on Chronic Liver Failure and Severe Alcoholic Hepatitis – Preliminary Experience
TL;DR: In this article , low-volume PLEX and low-dose steroids with standard medical treatment (SMT) were compared for one year survival in A-ACLF patients with severe alcoholic hepatitis.
Journal ArticleDOI
Recognizing dysfunctional innate and adaptive immune responses contributing to liver damage in patients with cirrhosis.
TL;DR: In this article, the authors discuss the tests which reflect aberrant immune responses in patients with cirrhosis and treatment of the same and how does the immune system in a patient with liver disease respond to SARS CoV2 infection.
Journal ArticleDOI
Recognizing Dysfunctional Innate and Adaptive Immune Responses Contributing to Liver Damage in Patients With Cirrhosis
TL;DR: In this paper , the authors discuss the tests which reflect aberrant immune responses and treatment of patients with cirrhosis and how the immune system in a patient with liver disease respond to SARS CoV2 infection.
References
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Journal ArticleDOI
The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine.
Jean Louis Vincent,R. Moreno,Jukka Takala,Sheila Willatts,A. de Mendonça,Hajo A. Bruining,C. K. Reinhart,P. M. Suter,L. G. Thijs +8 more
TL;DR: The ESICM developed a so-called sepsis-related organ failure assessment (SOFA) score to describe quantitatively and as objectively as possible the degree of organ dysfunction/failure over time in groups of patients or even in individual patients.
Journal ArticleDOI
Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis
Richard Moreau,Rajiv Jalan,Pere Ginès,Marco Pavesi,Paolo Angeli,Juan Córdoba,François Durand,Thierry Gustot,Faouzi Saliba,Marco Domenicali,Alexander L. Gerbes,Julia Wendon,Carlo Alessandria,Wim Laleman,Stefan Zeuzem,Jonel Trebicka,Mauro Bernardi,Vicente Arroyo +17 more
TL;DR: Diagnostic criteria for ACLF was established and showed that it is distinct from AD, based not only on the presence of organ failure(s) and high mortality rate but also on age, precipitating events, and systemic inflammation.
Journal ArticleDOI
Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the study of the liver (APASL)
Shiv Kumar Sarin,Ashok Kumar,John A. Almeida,Yogesh Chawla,Sheung Tat Fan,Hitendra Garg,H. Janaka de Silva,Saeed Hamid,Rajiv Jalan,Piyawat Komolmit,George K. K. Lau,Qing Liu,Kaushal Madan,Rosmawati Mohamed,Qin Ning,Salimur Rahman,Archana Rastogi,Stephen M. Riordan,Puja Sakhuja,Didier Samuel,Samir Shah,Barjesh Chander Sharma,Praveen Sharma,Yasuhiro Takikawa,Babu Ram Thapa,Chun-Tao Wai,Man-Fung Yuen +26 more
TL;DR: The original proposed definition of ACLF was found to withstand the test of time and identify a homogenous group of patients presenting with liver failure, which led to the development of the final AARC consensus.
Journal ArticleDOI
Extracorporeal albumin dialysis with the molecular adsorbent recirculating system in acute-on-chronic liver failure: the RELIEF trial
Rafael Bañares,Rafael Bañares,Frederik Nevens,Fin Stolze Larsen,Rajiv Jalan,Agustín Albillos,Matthias M. Dollinger,Faouzi Saliba,Faouzi Saliba,Tilman Sauerbruch,Sebastian Klammt,Johann Ockenga,Albert Parés,Julia Wendon,Tanja Brünnler,Ludwig Kramer,Philippe Mathurin,Manuel de la Mata,Antonio Gasbarrini,Beat Müllhaupt,Alexander Wilmer,Wim Laleman,Martin Eefsen,Sambit Sen,Alexander Zipprich,Teresa Tenorio,Marco Pavesi,Hartmut Schmidt,Steffen Mitzner,Roger Williams,Vicente Arroyo +30 more
TL;DR: At scheduled doses, a beneficial effect on survival of MARS therapy in patients with ACLF could not be demonstrated, however, MARS has an acceptable safety profile, has significant dialysis effect, and nonsignificantly improves severe HE.
Journal ArticleDOI
Acute-on-chronic liver failure: an update
TL;DR: Using a liver-adapted sequential organ assessment failure score, it is possible to triage and prognosticate the outcome of patients with ACLF and bioartificial liver support systems, granulocyte-colony stimulating factors or stem-cell transplant are in the horizon of medical care; however, data are too premature to implement them as standard of care.
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