ABSTRACT
Acute on chronic liver failure is an increasingly recognized syndrome characterized by acute decompensation of chronic liver disease associated with organ failure and high short-term mortality. ACLF is frequent, affecting between 24 and 40% of patients admitted for complications of cirrhosis. Sepsis, active alcoholism, and relapse of chronic viral hepatitis are the most frequent precipitating factors. However, in up to 40%50% of the cases of ACLF have no identifiable trigger. The stage of severity of Acute on chronic liver failure is very important because it allows us to stratify patients according to their prognosis, evaluate therapeutic response, determine transplant urgency, deciding intensive care unit admission, and also have a basis on which to decide therapeutic futility. (AU)
Subject(s)
Humans , Acute-On-Chronic Liver Failure/diagnosis , Acute-On-Chronic Liver Failure/physiopathology , Liver Failure, Acute , Acute-On-Chronic Liver Failure/therapyABSTRACT
Acute on chronic liver failure (ACLF) is an increasingly recognized syndrome worldwide, in which there is great interest from different scientific societies and an increasing number of publications. It is defined as a syndrome of cirrhotic patients, characterized by the presence of acute decompensation, organ failure and high mortality rate in the short term. ACLF can be reversed using standard therapy in only 16-50% of patients, thus a prompt transfer to liver transplant center can make a difference in the survival chances of the patient.
La falla hepática aguda sobre crónica (ACLF, por su sigla en inglés) es un síndrome cada vez más reconocido a nivel mundial, que genera gran interés por parte de las distintas sociedades científicas y sobre el cual existe un número creciente de publicaciones. Se define como un síndrome de pacientes cirróticos, que se caracteriza por la presencia de una descompensación aguda, falla orgánica y elevada mortalidad a corto plazo. La reversibilidad de este síndrome con las medidas estándar es solo entre 16-50%, por lo que la derivación a un centro con disponibilidad de trasplante hepático puede hacer la diferencia en la sobrevida del paciente.
Subject(s)
Humans , Acute-On-Chronic Liver Failure/diagnosis , Acute-On-Chronic Liver Failure/therapy , Prognosis , Severity of Illness Index , Liver Transplantation , Acute-On-Chronic Liver Failure/etiology , Acute-On-Chronic Liver Failure/physiopathology , Acute-On-Chronic Liver Failure/prevention & controlABSTRACT
The decompensation of liver cirrhosis secondary to an identifiable injury (mainly infections among the potential causes) associated to failure of one or more organs (particularly the kidney). Proinflammatory citokines are involved in pathophysiology, produced as a consequence of the injury that triggers the condition. Mortality factors are the Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA); Model-For-End-Stage-Liver Disease (MELD); number of organs affected, and presence of leukocytosis. No specific treatment has been described yet that might have an impact on the mortality rates, therefore emphasis should made on prevention and/or diagnosis for early treatment of injuries (pneumonia and Spontaneous Bacterial Peritonitis-SBP among others) in order to prevent synthesis of cytokines that have a role in its pathophysiology.
La falla hepática aguda sobre crónica corresponde a una situación de alta mortalidad, pero potencialmente reversible. Conceptualmente corresponde a la descompensación de la cirrosis hepática secundaria a un daño cuya etiología es muchas veces identificable (destacando las infecciones entre las posibles causas) asociada a la falla de uno o más órganos (especialmente el riñón). En su patogenia actúan en forma importante citoquinas proinflamatorias que se generan como consecuencia del daño que gatilla el cuadro. Son factores pronósticos de mortalidad el Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA); Model-For-End-Stage-Liver Disease (MELD); número de órganos disfuncionantes y existencia de leucocitosis. Aún no se ha descrito ningún tratamiento específico que impacte en la mortalidad del cuadro, por lo que se debe enfatizar en prevenir y/o diagnosticar para tratar precozmente las causas de daño (neumonía y peritonitis bacteriana espontánea- PBE entre otros) y así evitar la síntesis de citoquinas que participan en su patogenia.