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Critical Care
Published in: Critical Care 6/2012

Open Access 01-12-2012 | Research

Role of predisposition, injury, response and organ failure in the prognosis of patients with acute-on-chronic liver failure: a prospective cohort study

Authors: Rajiv Jalan, Vanessa Stadlbauer, Sambit Sen, Lisa Cheshire, Yu-Mei Chang, Rajeshwar P Mookerjee

Published in: Critical Care | Issue 6/2012

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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.
Appendix
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Metadata
Title
Role of predisposition, injury, response and organ failure in the prognosis of patients with acute-on-chronic liver failure: a prospective cohort study
Authors
Rajiv Jalan
Vanessa Stadlbauer
Sambit Sen
Lisa Cheshire
Yu-Mei Chang
Rajeshwar P Mookerjee
Publication date
01-12-2012
Publisher
BioMed Central
Published in
Critical Care / Issue 6/2012
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc11882

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