Systemic Inflammation and Organ Failure in Cirrhosis. The Acute-on-Chronic Liver Failure Syndrome

115 Pages·2016·6.78 MB·English

1ST INTERNATIONAL MEETING
Systemic Inflammation and
Organ Failure in Cirrhosis.
The Acute-on-Chronic Liver
Failure Syndrome (ACLF)

1ST INTERNATIONAL MEETING
Systemic Inflammation and
Organ Failure in Cirrhosis.
The Acute-on-Chronic Liver
Failure Syndrome (ACLF)

1ST INTERNATIONAL MEETING
Systemic Inflammation and
Organ Failure in Cirrhosis.
The Acute-on-Chronic Liver
Failure Syndrome (ACLF)
Vicente Arroyo
Mauro Bernardi
For the Canonic Study Investigators of the EASL-CLIF Consortium
EASL-CLIF Consortium.
Grifols Chair for Research and Education.
European Foundation for the Study of
Chronic Liver Failure (EF-CLIF).
© 2016 Elsevier España, S.L.
Av. Josep Tarradellas, 20-30
08029 Barcelona
© 2016 The editors
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ISBN: 978-84-759-2796-1
D.L.: B-5573-2016
Printed in Spain
INDEX
IN MEMORIAM JOAN CÓRDOBA VII
.........................
CONTRIBUTORS IX
.........................
LIST OF THE CANONIC STUDY INVESTIGATORS XI
.........................
MILESTONES XIII
.........................
INTRODUCTION XV
.........................
Mauro Bernardi and Vicente Arroyo
SECTION I ACLF: A new syndrome associated to systemic inflammation
Systemic inflammation as a driver in human disease 3
.........................
Agustín Albillos, María Úbeda, Leticia Muñoz and Melchor Álvarez-Mon
Acute on chronic liver failure: The syndrome 11
.........................
Cristina Solé, Elsa Solà and Pere Ginès
The burden of acute on chronic liver failure in USA 15
.........................
Alina A. Allen and Patrick S. Kamath
SECTION II Extrahepatic organ failure and mechanism of ACLF in cirrhosis
Characterization of systemic inflammation in ACLF. Role in organ failure 21
.........................
Joan Clària, Cristina López-Vicario, Esther Titos and José Alcaraz-Quiles
Mechanism of systemic inflammation in ACLF in cirrhosis 29
.........................
Richard Moreau
Translocation of bacteria and bacterial products from the intestinal lumen
in cirrhosis. Role of microbiota, intestinal mucosal integrity and local immune function 35
.........................
Phillipp Hartmann and Bernd Schnabl
Index
Bacterial infection in ACLF: An etiologic factor and a complication 43
.........................
Javier Fernández
Severe alcoholic hepatitis, systemic inflammation and multiorgan failure 47
.........................
Zahid M. Vashora, Joaquín Cabezas and Ramón Bataller
Cardiocirculatory failure and hepatorenal syndrome in cirrhosis:
role of systemic inflammation 53
.........................
Salvatore Piano and Paolo Angeli
Adrenal insufficiency in cirrhosis 59
.........................
Thierry Gustot, Verónica Prado and Javier Fernández
Inflammation and encephalopathy in acute and acute-on-chronic liver failure 63
.........................
Roger F. Butterworth
SECTION III Prognosis, prevention and treatment of ACLF
Prognostic assessment of patients with decompensated cirrhosis
and ACLF and role of early liver transplantation 71
.........................
Jane Macnaughtan and Rajiv Jalan
Prevention of organ failure and mortality in decompensated cirrhosis 77
.........................
Paolo Caraceni, Maurizio Baldassarre and Mauro Bernardi
The management of the patient with ACLF 85
.........................
Faouzi Saliba
IN MEMORIAM
This book is dedicated to the memory of Joan Córdoba Cardona, member of the EASL-CLIF Consortium Steering Committee,
excellent clinician and outstanding clinical investigator.
Joan Córdoba Cardona
We would like to dedicate this book to the memory of the much loved and respected friend, Professor Joan Córdoba, who
passed away prematurely at the age of 49 from cancer. Joan was a dedicated clinician, great scientist, mentor, friend, collaborator,
critic and was extremely enthusiastic about trying to find solutions for patients with cirrhosis. Although his main interest was
in studying hepatic encephalopathy, he was passionate about cirrhosis research. He was critical to the formation of the CLIF
Consortium and provided leadership to organisation and contributed significantly to its ultimate success.
Joan’s seminal scientific contributions are many. He was the first to show the importance of cerebral hyperemia in acute liver
failure, the deleterious consequences of hyponatremia in the development of brain edema, evidence that the brain of patients
with hepatic encephalopathy was irreversibly injured, the negative consequences of administering a low protein diet to patients
with hepatic encephalopathy, providing evidence for white matter lesions in patients with hepatic encephalopathy, generating
the first evidence of the safety and efficacy of a novel ammonia lowering compound, ornithine phenylacetate and showing for
the first time that the brain in patients with acute on chronic liver failure was clinically and pathophysiologically distinct.
However, his greatest contribution was his mentorship of many, many colleagues in the field of hepatic encephalopathy without
asking for anything in return.
Joan is desperately missed by the whole of the Hepatology community and remembered very fondly by all who knew him.
Rajiv Jalan
VII