ArticleLiver international : official journal of the International Association for the Study of the Liver2025
Impact of Underlying Portal Hypertension on Severity and Course of Acute-On-Chronic Liver Failure.
Article in Liver international : official journal of the International Association for the Study of the Liver, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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3 citing papers in PubMed.
- Endoscopic variceal ligation-induced ulcer bleeding: incidence by indication, real-world treatment, and outcomes.BMC gastroenterology · 2026Article
- [Research progress in the field of liver failure with artificial livers in 2025].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 2026Review
- Impact of Underlying Portal Hypertension on Severity and Course of Acute-On-Chronic Liver Failure.Liver international : official journal of the International Association for the Study of the Liver · 2025Article
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12 authors.
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Abstract
BACKGROUND AND
aimsThe impact of portal hypertension (PH) during acute-on-chronic liver failure (ACLF) remains unclear. This study investigated the link between underlying PH severity, systemic inflammation (SI), and the course of ACLF.
methodsConsecutive patients with ACLF (n = 192) who met the EASL-CLIF criteria were retrospectively included. PH severity (hepatic venous pressure gradient, HVPG; platelet count, PLT; and other clinical/radiologic PH surrogates) and SI (white blood cell count; C-reactive protein [CRP], interleukin-6) were assessed at the last pre-ACLF visit, ACLF diagnosis (D0), and after 7 (D7), 28 (D28), and 90 (D90) days.
resultsAll patients had clinical/radiological signs of PH, and 91 (47%) patients developed ACLF grade 1, 62 (32%) ACLF-2, and 39 (21%) ACLF-3. Patients with different D0-ACLF grades showed similar SI biomarker levels pre-ACLF, whereas these increased significantly during ACLF. Median PLT decreased in parallel with the ACLF grade and from D0 (ACLF-3:72; vs. ACLF-2:81; vs. ACLF-1:91 G/L; p = 0.094) to D7 (ACLF-3:39 vs. ACLF-2:64; vs. ACLF-1:89 G/L; p < 0.001). In multivariable Cox regression models, D0-PLT (aHR: 0.96 per 10 G/L [95% CI: 0.93-0.99], p = 0.015) independently predicted D28 mortality. A logistic regression model including sex, D0-PLT, D0-CRP, and CLIF-C ACLF score predicted D28 mortality (AUROC: 0.79 [0.73-0.86]; p < 0.001) and outperformed (p = 0.036) the MELD-Na score (AUROC: 0.71 [0.63-0.78]; p < 0.001).
conclusionsAlthough PH is a necessary condition for ACLF development, underlying PH severity does not confer a risk for higher ACLF severity but impacts survival after ACLF resolution. PLT emerged as a predictor of D28 mortality, independent of the CLIF-C ACLF score.
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