Evidence map›Paper›PMID 33436495›Full record

SynthesisGut2022

Global burden of disease: acute-on-chronic liver failure, a systematic review and meta-analysis.

Gabriel Mezzano, Adria Juanola, Andres Cardenas, Esteban Mezey, James P Hamilton, Elisa Pose, Isabel Graupera, Pere Ginès, Elsa Solà, Ruben Hernaez

Registry-linked trialAbstract readMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Gut, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06740149 (Efficacy and Safety of Allogeneic Human Bone Marrow Mesenchymal Stem Cells for the Treatment of Patients With Acute-on-chronic Liver Failure), which is not on this map. Cited by 125 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
125citing papers in PubMed, 8 pooled it
18.5field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06740149 phase1 / phase2completednot on this mapstarted 2023, after this paper: background citation

Efficacy and Safety of Allogeneic Human Bone Marrow Mesenchymal Stem Cells for the Treatment of Patients With Acute-on-chronic Liver Failure

TypeinterventionalSponsorSun Yat-sen UniversityRan2023 to 2026Enrolled90ConditionsAcute-On-Chronic Liver FailureArmsBone marrow mesenchymal stem cells (low dose), Solvent of CG-BM1, Bone marrow mesenchymal stem cells (medium dose), Bone marrow mesenchymal stem cells (high dose)
3 · Its place in the literature

Who cites it

125 citing papers in PubMed, 8 syntheses or guidelines pooled it, 227 citations in OpenAlex.

  1. Pooled it
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  3. [Guidelines for the diagnosis and treatment of acute-on-chronic liver failure (2025 version)].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 2025
    Guideline
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65 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors at 4 institutions in 3 countries.

Gabriel Mezzano *Liver Unit, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain.
Adria Juanola *Liver Unit, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain.
Andres CardenasInstitut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
Esteban MezeyDivision of Gastroenterology and Hepatology. Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
James P HamiltonDivision of Gastroenterology and Hepatology. Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Elisa PoseLiver Unit, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain.
Isabel GrauperaLiver Unit, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain.
Pere GinèsLiver Unit, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain.ORCID 0000-0003-4657-4504
Elsa SolàLiver Unit, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain.
Ruben HernaezGastroenterology and Hepatology, Depatment of Medicine, Baylor College of Medicine, Houston, Texas, USA ruben.hernaez@bcm.edu.ORCID 0000-0002-1518-4020
Hospital Clínic de Barcelona · ESJohns Hopkins University · USHospital del Salvador · CLMichael E. DeBakey VA Medical Center · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

aimsAcute-on-chronic liver failure (ACLF) is characterised by acute decompensation of cirrhosis associated with organ failures. We systematically evaluated the geographical variations of ACLF across the world in terms of prevalence, mortality, aetiology of chronic liver disease (CLD), triggers and organ failures.

methodsWe searched EMBASE and PubMed from 3/1/2013 to 7/3/2020 using the ACLF-EASL-CLIF (European Association for the Study of the Liver-Chronic Liver Failure) criteria. Two investigators independently conducted the abstract selection/abstraction of the aetiology of CLD, triggers, organ failures and prevalence/mortality by presence/grade of ACLF. We grouped countries into Europe, East/South Asia and North/South America. We calculated the pooled proportions, evaluated the methodological quality using the Newcastle-Ottawa Scale and statistical heterogeneity, and performed sensitivity analyses.

resultsWe identified 2369 studies; 30 cohort studies met our inclusion criteria (43 206 patients with ACLF and 140 835 without ACLF). The global prevalence of ACLF among patients admitted with decompensated cirrhosis was 35% (95% CI 33% to 38%), highest in South Asia at 65%. The global 90-day mortality was 58% (95% CI 51% to 64%), highest in South America at 73%. Alcohol was the most frequently reported aetiology of underlying CLD (45%, 95% CI 41 to 50). Infection was the most frequent trigger (35%) and kidney dysfunction the most common organ failure (49%). Sensitivity analyses showed regional estimates grossly unchanged for high-quality studies. Type of design, country health index, underlying CLD and triggers explained the variation in estimates.

conclusionsThe global prevalence and mortality of ACLF are high. Region-specific variations could be explained by the type of triggers/aetiology of CLD or grade. Health systems will need to tailor early recognition and treatment of ACLF based on region-specific data.

Indexed as

Global Burden of DiseaseAcute-On-Chronic Liver FailureHumansInfectionsLiver Diseases, AlcoholicPrevalenceRenal Insufficiencycirrhosisliver failure

Identifiers

PMID33436495
OpenAlexW3119881433

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.