PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis

• DOI: 10.1016/j.jhep.2020.11.019
• Publication Date: 2020-11-20T11:29:53Z
• Authors: Jonel Trebicka; Javier Fernandez; Maria Papp; Paolo Caraceni; Wim Laleman; Carmine Gambino; Ilaria Giovo; Frank Erhard Uschner; Christian Jansen; Cesar Jimenez; Rajeshwar Mookerjee; Thierry Gustot; Agustin Albillos; Rafael Bañares; Peter Jarcuska; Christian Steib; Thomas Reiberger; Juan Acevedo; Pietro Gatti; Debbie L. Shawcross; Stefan Zeuzem; Alexander Zipprich; Salvatore Piano; Thomas Berg; Tony Bruns; Karen Vagner Dani...; Minneke Coenraad; Manuela Merli; Rudolf Stauber; Heinz Zoller; José Presa Ramos; Cristina Solé; Germán Soriano; Andrea de Gottardi; Henning Gronbaek; Faouzi Saliba; Christian Trautwein; Haluk Tarik Kani; Sven Francque; Stephen Ryder; Pierre Nahon; Manuel Romero-Gomez; Hans Van Vlierberghe; Claire Francoz; Michael Manns; Elisabet Garcia-L...; Manuel Tufoni; Alex Amoros; Marco Pavesi; Cristina Sanchez; Michael Praktiknjo; Anna Curto; Carla Pitarch; Antonella Putignano; Esau Moreno; William Bernal; Ferran Aguilar; Joan Clària; Paola Ponzo; Zsuzsanna Vitalis; Giacomo Zaccherini; Boglarka Balogh; Alexander Gerbes; Victor Vargas; Carlo Alessandria; Mauro Bernardi; Pere Ginès; Richard Moreau; Paolo Angeli; Rajiv Jalan; Vicente Arroyo; Miriam Maschmeier; David Semela; Laure Elkrief; Ahmed Elsharkawy; Tamas Tornai; Istvan Tornai; Istvan Altorjay; Agnese Antognoli; Maurizio Baldassarre; Martina Gagliardi; Eleonora Bertoli; Sara Mareso; Alessandra Brocca; Daniela Campion; Giorgio Maria Sar...; Martina Rizzo; Jennifer Lehmann; Alessandra Pohlmann; Maximilian J. Brol; Johannes Chang; Robert Schierwagen; Elsa Solà; Nesrine Amari; Miguel Rodriguez; Frederik Nevens; Ana Clemente; Martin Janicko; Daniel Markwardt; Mattias Mandorfer; Christoph Welsch; Tanja M. Welzel; Emanuela Ciraci; Vish Patel; Cristina Ripoll; Adam Herber; Paul Horn; Flemming Bendtsen; Lise Lotte Gluud; Jelte Schaapman; Oliviero Riggio; Florian Rainer; Jörg Tobiasch Moritz; Mónica Mesquita; Edilmar Alvarado-...; Osagie Akpata; Luise Aamann; Didier Samuel; Sylvie Tresson; Pavel Strnad; Roland Amathieu; Macarena Simón-Ta...; Francois Smits; Natalie van den Ende; Javier Martinez; Rita Garcia; Harald Rupprechter; Cornelius Engelmann; Osman Cavit Özdogan
• Keywords: Alcoholic Hepatitis; Decompensation; Hepatic Encephalopathy; Spontaneous bacterial peritonitis

Acute decompensation (AD) of cirrhosis may present without acute-on-chronic liver failure (ACLF) (AD-No ACLF), or with ACLF (AD-ACLF), defined by organ failure(s). Herein, we aimed to analyze and characterize the precipitants leading both these AD phenotypes. The multicenter, prospective, observational PREDICT study (NCT03056612) included 1,273 non-electively hospitalized patients (No = 1,071; 202). Medical history, clinical data laboratory were collected at enrolment during 90-day follow-up, particular attention given following characteristics precipitants: induction dysfunction failure, systemic inflammation, chronology, intensity, relationship outcome. Among various events, 4 distinct events consistently related AD: proven bacterial infections, severe alcoholic hepatitis, gastrointestinal bleeding shock toxic encephalopathy. in AD-No cohort AD-ACLF (38% 71%, respectively), almost all (96% 97%, respectively) showed infection either alone combination other events. Survival was similar infections hepatitis number associated significantly increased mortality paralleled increasing levels surrogates for inflammation. Importantly, adequate first-line antibiotic treatment a lower development rate mortality. This identified that are course prognosis AD. Specific preventive therapeutic strategies targeting improve outcomes decompensated cirrhosis. is characterized rapid deterioration patient health. precipitating cause Proven combination, accounted (96-97%) cases failure. Whilst type precipitant not mortality, precipitant(s) was. outcomes.