ArticleCritical care (London, England)2012
Role of predisposition, injury, response and organ failure in the prognosis of patients with acute-on-chronic liver failure: a prospective cohort study.
Article in Critical care (London, England), 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 53 papers.
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Who cites it
53 citing papers in PubMed, 124 citations in OpenAlex.
- Plasminogen as a prognostic biomarker for HBV-related acute-on-chronic liver failure.The Journal of clinical investigation · 2020Trial
- Novel prognostic scoring models for hepatitis B virus-related acute-on-chronic liver failure: A comparison with classical models.Virulence · 2025Article
- Prognostic value of combined detection of alpha-fetoprotein, plasma prothrombin activity, and serum prealbumin in acute-on-chronic liver failure.World journal of gastrointestinal surgery · 2025Article
- Impact of acute respiratory distress syndrome on outcome in critically ill patients with liver cirrhosis.Scientific reports · 2025Article
- Article
- Novel Therapeutic Approaches in Treatment of Acute-on-Chronic Liver Failure.Seminars in liver disease · 2023Review
- Serum interleukin-6 level predicts the prognosis for patients with alcohol-related acute-on-chronic liver failure.Hepatology international · 2023Article
- Outcomes and time trends of acute respiratory distress syndrome patients with and without liver cirrhosis: an observational cohort.Annals of intensive care · 2023Article
- Potential of circulating receptor-interacting protein kinase 3 levels as a marker of acute liver injury.Scientific reports · 2023Article
- Acute-on-chronic liver failure: Terminology, mechanisms and management.Clinical and molecular hepatology · 2023Review
- PIRO-CIC model can predict mortality and futility of care in critically ill cirrhosis patients in the intensive care unit.Hepatology international · 2023Article
- Pathophysiology and management of liver cirrhosis: from portal hypertension to acute-on-chronic liver failure.Frontiers in medicine · 2023Review
- The progress to establish optimal animal models for the study of acute-on-chronic liver failure.Frontiers in medicine · 2023Review
- Prevalence and clinical characteristics of autoimmune liver disease in hospitalized patients with cirrhosis and acute decompensation in China.World journal of gastroenterology · 2022Article
- Overt hepatic encephalopathy is an independent risk factor for de novo infection in cirrhotic patients with acute decompensation.Alimentary pharmacology & therapeutics · 2022Article
- Impact of compensated cirrhosis on survival in patients with acute-on-chronic liver failure.Hepatology international · 2022Article
- Liver transplantation in Acute-on-Chronic liver failure: Timing of transplantation and selection of patient population.Frontiers in medicine · 2022Review
- Predictors for oesophageal candidiasis in patients with liver cirrhosis.Le infezioni in medicina · 2022Article
- The role of RIPK1 mediated cell death in acute on chronic liver failure.Cell death & disease · 2021Article
- Baseline serum cystatin C as a marker of acute kidney injury in patients with acute-on-chronic liver failure.Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology · 2021Observational
Corrections and comments
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Authors and funding
6 authors at 4 institutions in 2 countries.
Funding
Abstract
introductionAcute 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.
methodsA 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.
resultsOne 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.
conclusionsThe 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.
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