• end-stage liver disease
• alcoholic hepatitis
• alcohol
• machine learning
• outcome prediction

• Humans
• Male
• Female
• Artificial Intelligence
• Middle Aged
• Retrospective Studies
• Hepatitis, Alcoholic/mortality
• Hepatitis, Alcoholic/drug therapy
• Adult
• Prognosis
• Cohort Studies
• Aged

• P50 AA024333 NIAAA NIH HHS
• U01 AA020821 NIAAA NIH HHS
• U01 AA021908 NIAAA NIH HHS
• UL1 TR001863 NCATS NIH HHS

• Humans
• Acute-On-Chronic Liver Failure/therapy
• Acute-On-Chronic Liver Failure/diagnosis
• Liver Cirrhosis/complications
• Liver Cirrhosis/therapy
• Critical Illness/therapy
• Critical Care/methods
• Critical Care/standards

• hepatology
• alcoholic liver disease
• liver cirrhosis

• Humans
• Acute-On-Chronic Liver Failure/therapy
• Acute-On-Chronic Liver Failure/blood
• Male
• Female
• Middle Aged
• Retrospective Studies
• Aged
• Bilirubin/blood
• Intensive Care Units
• Adult
• Interleukin-6/blood
• Procalcitonin/blood
• Length of Stay

• NGAL
• cirrhosis
• hemodialysis
• hepatorenal syndrome
• mortality

• Anesthesia
• Cirrhosis
• Hepatitis
• Liver disease
• Perioperative

• C-reactive protein
• acute decompensation
• infection
• liver cirrhosis
• mortality
• neutrophil-to-lymphocyte ratio
• procalcitonin
• white blood cell

• Acute-on-chronic liver failure
• Esophageal and gastric varices
• Gastrointestinal hemorrhage
• Liver cirrhosis
• Organ dysfunction scores
• Prognosis

• Acute-on-chronic liver failure
• CLIF-C ACLF
• CLIF-C AD
• CLIF-SOFA
• End-stage liver disease

Sepsis-3 criteria and quick Sequential Organ Failure Assessment (qSOFA) have been advocated to be used in defining sepsis in the general population. We aimed to compare the Sepsis-3 criteria and Chronic Liver Failure-SOFA (CLIF-SOFA) scores as predictors of in-hospital mortality in cirrhotic patients admitted to the emergency department (ED) for infections.

A total of 1,622 cirrhosis patients admitted at the ED for infections were assessed retrospectively. We analyzed their demographic, laboratory, and microbiological data upon diagnosis of the infection. The primary endpoint was inhospital mortality rate. The predictive performances of baseline CLIF-SOFA, Sepsis-3, and qSOFA scores for in-hospital mortality were evaluated.

The CLIF-SOFA score proved to be significantly better in predicting in-hospital mortality (area under the receiver operating characteristic curve [AUROC], 0.80; 95% confidence interval [CI], 0.78–0.82) than the Sepsis-3 (AUROC, 0.75; 95% CI, 0.72–0.77, P<0.001) and qSOFA (AUROC, 0.67; 95% CI, 0.64–0.70; P<0.001) score. The CLIF-SOFA, CLIF-C-AD scores, Sepsis-3 criteria, septic shock, and qSOFA positivity were significantly associated with in-hospital mortality (adjusted hazard ratio [aHR], 1.24; 95% CI, 1.19–1.28; aHR, 1.13; 95% CI, 1.09–1.17; aHR, 1.19; 95% CI, 1.15–1.24; aHR, 1.88; 95% CI, 1.42–2.48; aHR, 2.06; 95% CI, 1.55–2.72; respectively; all P<0.001). For CLIF-SOFA scores ≥6, in-hospital mortality was >10%; this is the cutoff point for the definition of sepsis.

Among cirrhosis patients presenting with infections at the ED, CLIF-SOFA scores showed a better predictive performance for mortality than both Sepsis-3 criteria and qSOFA scores, and can be a useful tool of risk stratification in cirrhotic patients requiring timely intervention for infection.

Background: Cirrhosis progression varies greatly from patient to patient due to a variety of factors, including hepatic reserve, cirrhosis etiology, and the presence of hepatocellular cancer. As a result, determining a prognosis in a patient with cirrhosis remains a difficult task. For nearly three decades, the Child-Pugh score (CPS) has been the gold standard for determining the prognosis of cirrhosis. In the last two decades, many prognostic models and scores like a model for end-stage liver disease (MELD), chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score, peripheral blood lymphocyte to monocyte ratio (LMR) have been presented to predict prognosis in patients with cirrhosis and to choose the best therapy option. The aim of our study is to determine which score is more effective in predicting three-month mortality and whether these scores are equally effective in predicting short-term outcomes.

Materials & methods: In this hospital-based longitudinal study, we analyzed 140 patients with cirrhosis of liver visiting All India Institute of Medical Sciences Bhopal between July 2019 and July 2020. All the 140 patients were followed up for three months to establish short-term outcomes. The blood investigations were done at the time of presentation from all the patients and after three months in the survivors. Various scores were calculated.

Results: The majority of patients (47%) were in Child-Pugh class C. Mean MELD score was 13.54, LMR score was 1.96 and CLIF-SOFA score was 5. The total bilirubin, serum creatinine, international normalized ratio (INR), total leukocyte count, absolute monocyte count, CPS, MELD, CLIF-SOFA were significantly higher in a non-surviving group as compared to the surviving group, whereas the albumin and LMR significantly decreased in the non-surviving group. On performing multivariate regression, LMR and CLIF-SOFA were significant independent risk factors of mortality after adjusting for confounding factors. All the parameters had significant discriminatory power to predict mortality. Discriminatory power of CLIF-SOFA (AUC 0.808; 95% CI: 0.733 to 0.870) was excellent and discriminatory power of CPS (AUC 0.792; 95% CI: 0.716 to 0.856), MELD score (AUC 0.765; 95% CI: 0.685 to 0.832) and LMR (AUC 0.75; 95% CI: 0.669 to 0.819) was acceptable. Among all the parameters, CLIF-SOFA was the best predictor of mortality at a cut-off point of >5 with 80.80% chances of correctly predicting mortality.

Conclusion: The significant morbidity and mortality indicators are high total bilirubin, high creatinine, high INR, high TLC, low platelet count, and low albumin. Among the various scores, CLIF-SOFA is a better predictor of mortality and morbidity. Low LMR and high CLIF-SOFA are significant independent risk factors of mortality at three months.

• Acute-on-chronic hepatitis B liver failure
• Classification and regression tree
• Logistic regression model
• MELD scores

• Acute-On-Chronic Liver Failure/complications
• Adolescent
• Cohort Studies
• Humans
• Liver Cirrhosis/complications
• Peritonitis
• Prognosis
• Retrospective Studies

Acute-on-chronic liver failure (ACLF) is an extremely clinical entity associated with short-term high mortality. The CLIF-SOFA score measures both hepatic and extrahepatic organ dysfunction and can discriminate significantly better between survivors and nonsurvivors compared to other methods. The MELD score is widely used for organ allocation in liver transplantation. Recent reports indicate that the PWR is a potential biomarker for predicting clinical outcomes. The ALBI score is a new score model for evaluating the severity of liver dysfunction. We aimed to compare these prognosis models to predict short-term mortality in ACLF patients.

A retrospective analysis of 89 ACLF patients between 2015 and 2018 was performed. The receiver operating characteristic (ROC) curve was used to assess the power of four prognosis models for predicting 28-day mortality in patients with ACLF.

The ALBI score, MELD score and CLIF-SOFA score were significantly higher, and the PWR was slightly lower in nonsurviving ACLF patients than in surviving patients. The MELD score and ALBI score were positively correlated with the CLIF-SOFA score, while the PWR was inversely related to the CLIF-SOFA score. The area under the ROC curves (AUROCS) of the CLIF-SOFA score, PWR, ALBI score and MELD score were 0.804, 0.759, 0.710 and 0.670, respectively.

The CLIF-SOFA score, PWR and ALBI score can better predict 28-day mortality in ACLF patients, but the MELD score has worse predictability. The CLIF-SOFA score is the best prognosis model among these models. PWR may be a simple and useful tool that can predict 28-day outcome.

• CLIF-SOFA score
• acute-on-chronic liver failure
• albumin-bilirubin score
• platelet-to-white blood cell ratio
• prognosis

• alcoholism
• chronic alcoholism
• disability
• mortality
• people with disability

• APACHE III
• CLIF-C ACLF
• CLIF-OFs
• Time-dependent ROC curve
• acute-on-chronic liver failure (ACLF)
• specialized liver intensive care unit

• Acute liver failure
• acute liver failure
• acute on chronic liver failure
• critical care
• intensive care
• liver cirrhosis
• mortality prediction
• prediction model

• Cardiovascular complications
• Early allograft dysfunction
• Inflammation
• Interleukin-6
• Renal failure

Supplemental Digital Content is available in the text.

To better describe the outcomes of acute respiratory distress syndrome in mechanically ventilated patients with cirrhosis.

• adult respiratory distress syndrome
• cirrhosis
• intensive care
• mechanical ventilation

Patients with acute-on-chronic liver failure (ACLF) precipitated by hepatic injury and extrahepatic insults had distinct clinical phenotypes, and prognosis. This study aimed to validate prognostic models for ACLF and to explore their discriminative abilities in ACLF population categorized by the etiologies of precipitating events.

This study collected data from 343 consecutive cirrhotic patients hospitalized with the diagnosis of ACLF according to the EASL-CLIF-Consortium definition. The discrimination abilities of prognostic models at the onset of ACLF were tested with the concordance index and area under the receiver operating characteristic curve.

Among the entire cohort, 103 patients survived with medical management, nine patients were transplanted, and 231 patients died without liver transplantation. The predictive accuracy of the Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA) for 28-day mortality was similar to the CLIF Consortium Organ Failure (CLIF-C OF) but significantly higher than the CLIF Consortium ACLF, the Child-Turcotte-Pugh, the model for end-stage liver disease (MELD), the MELD-sodium, the integrated MELD, and the Acute Physiology and Chronic Health Evaluation II. Of note, 44 patients had acute hepatic insult triggering ACLF (hepatic-ACLF), 244 were exclusively precipitated by bacterial infection or gastrointestinal bleeding (extrahepatic-ACLF), and 55 cases had no any identifiable potential precipitating events. Patients with hepatic-ACLF had significantly higher 28-day mortality than extrahepatic-ACLF patients. The CLIF-SOFA and CLIF-C OF displayed the highest accuracy significantly outperforming other scoring systems in predicting mortality among patients with hepatic-ACLF and those with extrahepatic-ACLF.

The CLIF-SOFA and simpler CLIF-C OF are reliable measures of mortality risk in ACLF patients precipitated by either hepatic or extrahepatic insults. Both validated models could be used to stratify the risk of death and improve management of ACLF.

• Acute-On-Chronic Liver Failure/diagnosis
• Acute-On-Chronic Liver Failure/etiology
• Acute-On-Chronic Liver Failure/mortality
• Adult
• Aged
• End Stage Liver Disease/complications
• End Stage Liver Disease/diagnosis
• Female
• Hospital Mortality
• Humans
• Liver Cirrhosis/complications
• Liver Cirrhosis/diagnosis
• Male
• Middle Aged
• Prognosis
• ROC Curve
• Retrospective Studies
• Risk Assessment/methods
• Severity of Illness Index

• the Siriraj Research Development Fund

Dynamic susceptibility contrast enhanced magnetic resonance imaging (DSC MRI) is widely used for studying blood perfusion in brain tumors. While the time-dependent change of MRI signals related to the concentration of the tracer is used to derive the hemodynamic parameters such as regional blood volume and flow into tumors, the tissue-specific information associated with variations in profiles of signal time course is often overlooked. We report a new approach of combining model free independent component analysis (ICA) identification of specific signal profiles of DSC MRI time course data and extraction of the features from those time course profiles to interrogate time course data followed by calculating the region specific blood volume based on selected individual time courses. Based on the retrospective analysis of DSC MRI data from 38 patients with pathology confirmed low (n = 18) and high (n = 20) grade gliomas, the results reveal the spatially defined intra-tumoral hemodynamic heterogeneity of brain tumors based on features of time course profiles. The hemodynamic heterogeneity as measured by the number of independent components of time course data is associated with the tumor grade. Using 8 selected signal profile features, machine-learning trained algorithm, e.g., logistic regression, was able to differentiate pathology confirmed low intra-tumoral and high grade gliomas with an accuracy of 86.7%. Furthermore, the new method can potentially extract more tumor physiological information from DSC MRI comparing to the traditional model-based analysis and morphological analysis of tumor heterogeneity, thus may improve the characterizations of gliomas for better diagnosis and treatment decisions.

•

Signal profiles of dynamic susceptibility contrast MRI data of brain tumors reflect hemodynamic properties of tumor tissue.

• Brain tumor
• Cerebral blood volume
• Dynamic susceptibility contrast
• Feature extraction
• Magnetic resonance imaging
• Signal time course

• cirrhosis
• acute kidney injury
• acute tubular necrosis
• angiopoietin
• hepatorenal syndrome

• Accuracy
• Decompensated
• Liver cirrhosis
• Meta-analysis
• Mortality

• Acute-On-Chronic Liver Failure/diagnosis
• Acute-On-Chronic Liver Failure/etiology
• Acute-On-Chronic Liver Failure/therapy
• Disease Progression
• Europe
• Gastroenterology/methods
• Gastroenterology/standards
• Humans
• Liver Cirrhosis/etiology
• Liver Cirrhosis/physiopathology
• Liver Cirrhosis/therapy
• Patient Care Management/methods
• Practice Patterns, Physicians'/standards
• Prognosis
• Quality Improvement

• 乙型肝炎
• 慢加急性肝衰竭
• 长期预后
• 生存质量
• hepatitis b virus
• acute-on-chronic liver failure
• prognosis
• quality of life

• Acute-On-Chronic Liver Failure/etiology
• Acute-On-Chronic Liver Failure/mortality
• Acute-On-Chronic Liver Failure/physiopathology
• Acute-On-Chronic Liver Failure/psychology
• Case-Control Studies
• Disease Progression
• Hepatitis B virus
• Hepatitis B, Chronic/complications
• Hepatitis B, Chronic/mortality
• Humans
• Liver Cirrhosis/complications
• Liver Cirrhosis/mortality
• Mortality
• Prognosis
• Quality of Life
• Survivors

• acute-on-chronic liver failure
• prognosis
• validation

• acute-on-chronic liver failure
• hepatitis B virus
• prognosis

• acute-on-chronic liver failure
• hepatitis B
• prognostic model

慢加急性肝衰竭(acute-on-chronic liver failure, ACLF)是以慢性肝病基础上发生的急性肝功能失代偿和短期高死亡率为主要临床特征的一种可逆的、复杂的临床综合征. 由于不同区域ACLF的病因不同, 且病理机制复杂, 导致东西方对ACLF的定义及诊断标准仍存在争议, 且缺乏公认的预后评估体系. 近年来, ACLF引起了国内外学者的广泛关注, 取得了一些重要的研究进展, 本文将围绕国际上ACLF的最新进展, 对ACLF的定义及预后评估等进行分析总结.

• 慢加急性肝衰竭
• 定义
• 预后

• aclf grade
• acute-on-chronic liver failure
• clif consortium aclf score
• clif consortium organ failure score
• clif sequential organ failure assessment score
• hepatitis b virus
• model for end-stage liver disease score

• Acute-On-Chronic Liver Failure/complications
• Acute-On-Chronic Liver Failure/diagnosis
• Acute-On-Chronic Liver Failure/mortality
• Adolescent
• Adult
• Aged
• Area Under Curve
• Female
• Hepatitis B, Chronic/complications
• Hepatitis B, Chronic/diagnosis
• Hepatitis B, Chronic/mortality
• Humans
• Male
• Middle Aged
• Patient Acuity
• ROC Curve
• Time Factors
• Young Adult

• Acute liver failure
• Acute-on-chronic-liver failure
• CLIF-SOFA
• Chronic liver failure
• Extracorporeal liver support
• Fractionated plasma separation and adsorption
• Liver transplantation
• MELD
• Molecular Adsorbent Recirculating System
• Single pass albumin dialysis

• acute-on-chronic hepatitis B liver failure
• decision curves
• nomogram
• prediction
• time-dependent receiver operating characteristics

• acute-on-chronic hepatitis B liver failure
• classification and regression tree
• cohort study
• model for end-stage liver disease
• prognostic prediction

• Liver failure
• cirrhosis
• jaundice
• mortality
• sepsis

• Acute kidney injury
• Cirrhosis
• Hepatitis C
• Hepatorenal syndrome
• Liver immunology

• Acute-on-chronic liver failure
• CLIF-SOFA
• Cirrhosis
• Prognostic scoring systems
• SOFA

• alcoholic
• chronic liver failure-sequential organ failure assessment
• hepatic encephalopathy
• liver cirrhosis
• systemic inflammatory response syndrome

• End Stage Liver Disease/etiology
• Female
• Hepatic Encephalopathy/etiology
• Humans
• Liver Cirrhosis, Alcoholic/complications
• Male
• Middle Aged
• Organ Dysfunction Scores
• Prognosis
• Retrospective Studies
• Systemic Inflammatory Response Syndrome/etiology

The diagnostic and prognostic criteria of acute-on-chronic liver failure (ACLF) were developed in patients with no Hepatitis B virus (HBV) cirrhosis (CANONIC study). The aims of this study were to evaluate whether the diagnostic (CLIF-C organ failure score; CLIF-C OFs) criteria can be used to classify patients; and the prognostic score (CLIF-C ACLF score) could be used to provide prognostic information in HBV cirrhotic patients with ACLF. 890 HBV associated cirrhotic patients with acute decompensation (AD) were enrolled. Using the CLIF-C OFs, 33.7% (300 patients) were diagnosed as ACLF. ACLF was more common in the younger patients and in those with no previous history of decompensation. The most common organ failures were ‘hepatic’ and ‘coagulation’. As in the CANONIC study, 90-day mortality was extremely low in the non-ACLF patients compared with ACLF patients (4.6% vs 50%, p < 0.0001). ACLF grade and white cell count, were independent predictors of mortality. CLIF-C ACLFs accurately predicted short-term mortality, significantly better than the MELDs and a disease specific score generated for the HBV patients. Current study indicates that ACLF is a clinically and pathophysiology distinct even in HBV patients. Consequently, diagnostic criteria, prognostic scores and probably the management of ACLF should base on similar principles.

• TIPS placement
• Transjugular intrahepatic portosystemic shunt (TIPS)
• cirrhosis
• estimated glomerular filtration rate (eGFR)
• kidney
• large-volume paracentesis (LVP)
• liver
• mortality
• portal hypertension
• refractory ascites
• renal function

• acute-on-chronic liver failure
• chronic liver failure
• diagnosis
• liver failure
• prognosis
• treatment

• Acute-On-Chronic Liver Failure/diagnosis
• Acute-On-Chronic Liver Failure/etiology
• Acute-On-Chronic Liver Failure/physiopathology
• Acute-On-Chronic Liver Failure/therapy
• Humans
• Liver/physiopathology

Analysis of the transcriptome of peripheral blood mononuclear cells (PBMCs) from patients with hepatitis B-related acute-on-chronic liver failure (HBV-ACLF) is essential to elucidate the pathogenesis of HBV-ACLF and identify HBV-ACLF-specific biomarkers. In this study, high-throughput sequencing was performed to characterize the transcriptome of PMBCs from patients with HBV-ACLF. Specifically, 2381 differentially expressed genes (DEGs) and 776 differentially expressed transcripts were identified through comparisons with patients with chronic hepatitis B (CHB) and healthy controls. Gene Ontology (GO) analysis identified 114 GO terms that were clustered into 12 groups. We merged 10 dysregulated genes selected from these grouped GO terms and non-clustered terms with four significant genes with a specificity of >0.8 in the HBV-ACLF patients to obtain a set of 13 unique genes. The quantitative real-time polymerase chain reaction (qRT-PCR) validation of the top six genes (CYP19A1, SEMA6B, INHBA, DEFT1P, AZU1 and DEFA4) was consistent with the results of messenger ribonucleic acid (mRNA) sequencing. A further receiver operating characteristic (ROC) analysis revealed that the areas under the ROC curves of the six genes were all >0.8, which indicated their significant diagnostic potentials for HBV-ACLF. Conclusion: The transcriptome characteristics of PBMCs are altered in patients with HBV-ACLF, and six genes may serve as biomarkers of HBV-ACLF.

• Humans
• Liver Cirrhosis/complications
• Liver Cirrhosis/mortality
• Liver Cirrhosis/surgery
• Observational Studies as Topic
• Predictive Value of Tests
• Prognosis
• Severity of Illness Index