The Acute-on-Chronic Liver Failure Syndrome, or When the Innate Immune System Goes Astray.
The acute-on-chronic liver failure (ACLF) syndrome is characterized by acute decompensation of cirrhosis, organ failure, and high 28-d mortality. ACLF displays key features of systemic inflammation and its poor outcome is closely associated with exacerbated systemic inflammatory responses. In this review, we describe the prevailing characteristics of systemic inflammation in patients with decompensated cirrhosis and ACLF, with special emphasis on the principal features of the cytokine storm the mechanisms underlying this intense systemic inflammatory response (i.e., presence of circulating pathogen- and damage-associated molecular patterns), and their implication in tissue and organ damage in this condition.
Servei de Bioquímica i Genètica Molecular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona 08036, Spain; jclaria@clinic.cat.|Department of Biomedical Sciences, University of Barcelona, Barcelona 08036, Spain.
Joan
0000-0003-4333-7749
J
Clària
European Foundation for the Study of Chronic Liver Failure, Barcelona 08021, Spain; and.
Vicente
0000-0002-2728-1848
V
Arroyo
INSERM, Université Paris Diderot, Centre de Recherche sur l'Inflammation, Paris 75018, France.
Richard
0000-0003-0862-403X
R
Moreau
D065290:Acute-On-Chronic Liver Failure / Q000150:complications / Q000276:immunology* / Q000401:mortality / Q000503:physiopathology*; D016207:Cytokines / Q000276:immunology*; D006801:Humans; D007113:Immunity, Innate / Q000276:immunology*; D007249:Inflammation / Q000150:complications / Q000276:immunology / Q000503:physiopathology*; D008103:Liver Cirrhosis / Q000276:immunology / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index
D016207:Cytokines