Impact of Underlying Portal Hypertension on Severity and Course of Acute-On-Chronic Liver Failure

IF 5.2 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Liver International Pub Date : 2025-09-23 DOI:10.1111/liv.70363

Vlad Taru, Georg Kramer, Benedikt S. Hofer, Nina Dominik, Lorenz Balcar, Mathias Schneeweiss-Gleixner, Bogdan Procopet, Michael Trauner, Mattias Mandorfer, Philipp Schwabl, Thomas Reiberger, Benedikt Simbrunner

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Abstract

Background and Aims

The impact of portal hypertension (PH) during acute-on-chronic liver failure (ACLF) remains unclear. This study investigated the link between underlying PH severity, systemic inflammation (SI), and the course of ACLF.

Methods

Consecutive patients with ACLF (n = 192) who met the EASL-CLIF criteria were retrospectively included. PH severity (hepatic venous pressure gradient, HVPG; platelet count, PLT; and other clinical/radiologic PH surrogates) and SI (white blood cell count; C-reactive protein [CRP], interleukin-6) were assessed at the last pre-ACLF visit, ACLF diagnosis (D0), and after 7 (D7), 28 (D28), and 90 (D90) days.

Results

All patients had clinical/radiological signs of PH, and 91 (47%) patients developed ACLF grade 1, 62 (32%) ACLF-2, and 39 (21%) ACLF-3. Patients with different D0-ACLF grades showed similar SI biomarker levels pre-ACLF, whereas these increased significantly during ACLF. Median PLT decreased in parallel with the ACLF grade and from D0 (ACLF-3:72; vs. ACLF-2:81; vs. ACLF-1:91 G/L; p = 0.094) to D7 (ACLF-3:39 vs. ACLF-2:64; vs. ACLF-1:89 G/L; p < 0.001). In multivariable Cox regression models, D0-PLT (aHR: 0.96 per 10 G/L [95% CI: 0.93–0.99], p = 0.015) independently predicted D28 mortality. A logistic regression model including sex, D0-PLT, D0-CRP, and CLIF-C ACLF score predicted D28 mortality (AUROC: 0.79 [0.73–0.86]; p < 0.001) and outperformed (p = 0.036) the MELD-Na score (AUROC: 0.71 [0.63–0.78]; p < 0.001).

Conclusions

Although PH is a necessary condition for ACLF development, underlying PH severity does not confer a risk for higher ACLF severity but impacts survival after ACLF resolution. PLT emerged as a predictor of D28 mortality, independent of the CLIF-C ACLF score.

Abstract Image

查看原文本刊更多论文

潜在门脉高压对急性-慢性肝衰竭严重程度和病程的影响。

背景和目的：门静脉高压（PH）对急性慢性肝衰竭（ACLF）的影响尚不清楚。本研究探讨了潜在的PH严重程度、全身性炎症（SI）和ACLF病程之间的联系。方法：对符合EASL-CLIF标准的连续ACLF患者（n = 192）进行回顾性分析。在ACLF前最后一次就诊、ACLF诊断（D0）以及7 （D7）、28 （D28）和90 （D90）天后评估PH严重程度（肝静脉压梯度HVPG、血小板计数PLT和其他临床/放射学PH替代品）和SI（白细胞计数、c反应蛋白[CRP]、白细胞介素-6）。结果：所有患者均有PH的临床/影像学征象，91例（47%）患者发展为ACLF 1级，62例（32%）ACLF-2级，39例（21%）ACLF-3级。不同D0-ACLF分级的患者在ACLF前的SI生物标志物水平相似，而ACLF期间SI生物标志物水平显著升高。中位PLT与ACLF分级平行下降，从D0 （ACLF-3:72; vs. ACLF-2:81; vs. ACLF-1:91 G/L; p = 0.094）降至D7 (ACLF-3:39 vs. ACLF-2:64; vs. ACLF-1:89 G/L； p结论：尽管PH是ACLF发展的必要条件，潜在的PH严重程度并不会增加ACLF严重程度的风险，但会影响ACLF消退后的生存。PLT是D28死亡率的预测因子，独立于clifc - ACLF评分。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Liver International 医学-胃肠肝病学

CiteScore

13.90

自引率

4.50%

发文量

348

审稿时长

2 months

期刊介绍： Liver International promotes all aspects of the science of hepatology from basic research to applied clinical studies. Providing an international forum for the publication of high-quality original research in hepatology, it is an essential resource for everyone working on normal and abnormal structure and function in the liver and its constituent cells, including clinicians and basic scientists involved in the multi-disciplinary field of hepatology. The journal welcomes articles from all fields of hepatology, which may be published as original articles, brief definitive reports, reviews, mini-reviews, images in hepatology and letters to the Editor.