| Title |
Role of predisposition, injury, response and organ failure in the prognosis of patients with acute-on-chronic liver failure: a prospective cohort study
|
|---|---|
| Published in |
Critical Care, November 2012
|
| DOI | 10.1186/cc11882 |
| Pubmed ID | |
| Authors |
Rajiv Jalan, Vanessa Stadlbauer, Sambit Sen, Lisa Cheshire, Yu-Mei Chang, Rajeshwar P Mookerjee |
| Abstract |
ABSTRACT: INTRODUCTION: Acute deterioration of cirrhosis is associated with high mortality rates particularly in the patients who develop organ failure (OF), a condition that is referred to as acute-on-chronic liver failure (ACLF), which is currently not completely defined. This study aimed to determine the role of predisposing factors, the nature of the precipitating illness and inflammatory response in the progression to OF according to the PIRO (predisposition, injury, response, organ failure) concept to define the risk of in-hospital mortality. METHODS: A total of 477 patients admitted with acute deterioration of cirrhosis following a defined precipitant over a 5.5-year period were prospectively studied. Baseline clinical, demographic and biochemical data were recorded for all patients and extended serial data from the group that progressed to OF were analysed to define the role of PIRO in determining in-hospital mortality. RESULTS: One hundred and fifty-nine (33%) patients developed OF, of whom 93 patients died (58%) compared with 25/318 (8%) deaths in the non-OF group (P < 0.0001). Progression to OF was associated with more severe underlying liver disease and inflammation. In the OF group, previous hospitalisation (P of PIRO); severity of inflammation and lack of its resolution (R of PIRO); and severity of organ failure (O of PIRO) were associated with significantly greater risk of death. In the patients who recovered from OF, mortality at three years was almost universal. CONCLUSIONS: The results of this prospective study shows that the occurrence of OF alters the natural history of cirrhosis. A classification based on the PIRO concept may allow categorization of patients into distinct pathophysiologic and prognostic groups and allow a multidimensional definition of ACLF. |
X Demographics
The data shown below were collected from the profile of 1 X user who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 1 | 100% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 1 | 100% |
Mendeley readers
The data shown below were compiled from readership statistics for 75 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Hungary | 1 | 1% |
| United States | 1 | 1% |
| Italy | 1 | 1% |
| France | 1 | 1% |
| Unknown | 71 | 95% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Ph. D. Student | 11 | 15% |
| Researcher | 10 | 13% |
| Student > Master | 7 | 9% |
| Student > Bachelor | 7 | 9% |
| Other | 6 | 8% |
| Other | 17 | 23% |
| Unknown | 17 | 23% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 39 | 52% |
| Engineering | 3 | 4% |
| Unspecified | 2 | 3% |
| Immunology and Microbiology | 2 | 3% |
| Agricultural and Biological Sciences | 1 | 1% |
| Other | 5 | 7% |
| Unknown | 23 | 31% |
Attention Score in Context
This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 27 November 2012.
All research outputs
#20,655,488
of 25,371,288 outputs
Outputs from Critical Care
#5,970
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Outputs of similar age
#226,700
of 286,174 outputs
Outputs of similar age from Critical Care
#95
of 115 outputs
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