Acute-on-chronic liver failure (ACLF) is a common cause of death in patients with cirrhosis. In ACLF the progressive loss of function of the scarred liver can no longer be compensated (acute decompensation). As a result, other organs such as the kidney or brain fail. The triggers for acute decompensation of liver cirrhosis and an ACLF are most frequently bacterial infections, liver inflammation caused by alcohol, or a combination of both factors. This was revealed by the evaluation of the PREDICT study, which was conducted by an international team of researchers led by Professor Jonel Trebicka from the University Hospital Frankfurt.
Chronic liver disease and even cirrhosis can go unnoticed for a long time because many patients have no symptoms: the liver suffers silently. When the body is no longer able to compensate for the liver’s declining performance, the condition deteriorates dramatically in a very short time: tissue fluid collects in the abdomen (ascites), internal bleeding occurs in the oesophagus and elsewhere, and the brain is at risk of being poisoned by metabolic products. This acute decompensation of liver cirrhosis can develop into acute-on-chronic liver failure with inflammatory reactions throughout the body and failure of several organs.
In the PREDICT study, led by Professor Jonel Trebicka, scientists from 15 European countries observed 1273 patients who were hospitalized with acute decompensation of their liver cirrhosis. The current evaluation of the study focused on the question of what can trigger acute decompensation of liver cirrhosis. The result: in the vast majority of cases (>90%), a bacterial infection, liver inflammation caused by alcohol consumption, or both together could be identified as the trigger.
Bleeding in the digestive tract and brain dysfunction induced by painkillers or sedatives (drug-induced toxic encephalopathy) were identified as further trigger, although at a lower rate.
Lead investigator Professor Jonel Trebicka, gastroenterologist and hepatologist at the Medical Clinic I of the University Hospital Frankfurt, explains: “The acute decompensation of liver cirrhosis demands rapid and targeted action. In the PREDICT study, we therefore want to learn a lot about the triggering factors of this life-threatening disease in order to be able to derive recommendations for diagnostics and therapy. Knowing what the most likely triggers of acute decompensation are will help to further develop diagnostic and treatment strategies for patients with this life-threatening disease.”
The pan-European PREDICT study has monitored the clinical course of acute decompensations of liver cirrhosis to find early signs of the development of acute-on-chronic liver failure (ACLF). PREDICT is funded by the European Foundation for the Study of Chronic Liver Failure. A total of 136 scientists from 47 centres and institutions in 15 European countries are participating in PREDICT.
Publication: Jonel Trebicka, Javier Fernandez, et al. for the PREDICT STUDY group of the EASL-CLIF CONSORTIUM: PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis. Journal of Hepatology (2020), https://doi.org/10.1016/j.jhep.2020.11.019