title: The Clinical Course of Cirrhosis Patients Hospitalized for Acute Hepatic Deterioration: A Prospective Bicentric Study.
abstract: Patients with cirrhosis are vulnerable to acute hepatic insults and are more likely to develop rapid hepatic deterioration. The aim of this study is to describe the clinical course of patients with cirrhosis and hospitalized for acute hepatic deterioration (AHD).This is a prospective study involving 163 patients with cirrhosis and AHD. The occurrence of organ failures, systemic inflammatory response syndrome (SIRS), and infections during hospital stay were recorded and the relationship between organ failure and death or SIRS/infection was subsequently analyzed.Of 163 patients, 35 did not develop any organ failure during in-hospital follow-ups (90-day mortality: 0%); 84 had intrahepatic organ failures (IH-OFs, defined by liver and/or coagulation failure) (90-day mortality: 22.0%); and 44 patients developed extra-hepatic organ failures (EH-OFs, defined by kidney, cerebral, circulation, and respiratory failure) on the basis of IH-OF with a 90-day mortality of 90.9%. On multivariable analysis by a Cox proportion hazard model, age, WBC, presence of IH-OF, and EH-OF all predicted 90-day death. A logistic regression analysis identified SIRS being associated with the development of EH-OF. Furthermore, IH-OF at admission and infections occurred during the hospital stay were shown to be another 2 potential risk factors.The clinical course of cirrhosis patients with acute hepatic injury was characterized by 3 consecutive stages (AHD, IH-OF, and EH-OF), which provided a clear risk stratification. The PIRO criteria provided an accurate frame for prognostication of those patients. The systemic inflammatory response syndrome may be a target for blocking the progression to the EH-OF stage.
authors.affiliation: From the State Key Laboratory for Diagnosis and Treatment of Infectious, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (YS, ZZ, HF, YY, ZC, JS); Department of Infectious Diseases, Ningbo Multiple Organ Injury Research Center, Ningbo No. 2 Hospital, School of Medicine, Ningbo University, Ningbo, China (HY, WZ, JY, YH); Department of Cardiology, Ningbo Multiple Organ Injury Research Center, Ningbo No. 2 Hospital, School of Medicine, Ningbo University, Ningbo, China (HY); Department of Epidemiology and Health Statistics, Zhejiang University School of Public Health, Hangzhou, China (WS); Department of Infectious Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China (QY); and Center for Hepatology, University College London, London, United Kingdom (JL).
authors.forename: Yu
authors.initials: Y
authors.lastname: Shi
authors.forename: Huadong
authors.initials: H
authors.lastname: Yan
authors.forename: Zhibo
authors.initials: Z
authors.lastname: Zhou
authors.forename: Hong
authors.initials: H
authors.lastname: Fang
authors.forename: Jiawei
authors.initials: J
authors.lastname: Li
authors.forename: Honghua
authors.initials: H
authors.lastname: Ye
authors.forename: Wenjie
authors.initials: W
authors.lastname: Sun
authors.forename: Wenhong
authors.initials: W
authors.lastname: Zhou
authors.forename: Jingfen
authors.initials: J
authors.lastname: Ye
authors.forename: Qiao
authors.initials: Q
authors.lastname: Yang
authors.forename: Ying
authors.initials: Y
authors.lastname: Yang
authors.forename: Yaoren
authors.initials: Y
authors.lastname: Hu
authors.forename: Zhi
authors.initials: Z
authors.lastname: Chen
authors.forename: Jifang
authors.initials: J
authors.lastname: Sheng
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D000328:Adult; D002681:China / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D007958:Leukocyte Count / Q000379:methods; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis / Q000209:etiology / Q000401:mortality