Vulnerability to recurrent episodes of acute decompensation/acute-on-chronic liver failure characterizes those triggered by indeterminate precipitants in patients with liver cirrhosis Article Swipe
Hitomi Hoshi
,
Po–Sung Chu
,
Aya Yoshida
,
Nobuhito Taniki
,
Rei Morikawa
,
Karin Yamataka
,
Fumie Noguchi
,
Ryosuke Kasuga
,
Takaya Tabuchi
,
Hirotoshi Ebinuma
,
Hidetsugu Saito
,
Takanori Kanai∥
,
Nobuhiro Nakamoto
·
YOU?
·
· 2021
· Open Access
·
· DOI: https://doi.org/10.1371/journal.pone.0250062
YOU?
·
· 2021
· Open Access
·
· DOI: https://doi.org/10.1371/journal.pone.0250062
Background Acute decompensation (AD) of liver cirrhosis (LC) and subsequent acute-on-chronic liver failure (ACLF) are fatal and impair quality of life. Insufficient knowledge of the highly heterogeneous natural history of LC, including decompensation, re-compensation, and possible recurrent decompensation, hinders the development and application of novel therapeutics. Approximately 10%-50% of AD/ACLF is reported to be precipitated by any indeterminate (unidentifiable, cryptogenic, or unknown) acute insults; however, its clinical characteristics are unclear. Methods We conducted a single-center observational study of 2165 consecutively admitted patients with LC from January 2012 to December 2019. A total of 466 episodes of AD/ACLF in 285 patients, including their 285 first indexed AD/ACLF, were extracted for analysis. Stratified analyses of different acute precipitants, classified as indeterminate (AD/ACLF IND ), bacterial infection (AD/ACLF BAC ), gastrointestinal bleeding, active alcoholism, and miscellaneous, were performed. Results AD/ACLF IND was the leading acute precipitant (28%), followed by AD/ACLF BAC (23%). AD/ACLF IND showed better survival outcomes than AD/ACLF BAC ( P = 0.03); however, hyperbilirubinemia, hyponatremia, or leukocytosis significantly and uniquely characterized subgroups of AD/ACLF IND with comparable or even worse survival outcomes than those of AD/ACLF BAC . Patients with subsequent AD/ACLF significantly tended to suffer from AD/ACLF with any organ failure in AD/ACLF IND but not in AD/ACLF BAC ( P = 0.004, for trend). In competing risk analysis, patients with AD/ACLF IND were significantly more vulnerable to suffer from recurrent episodes of AD/ACLF within 180 days, compared to those triggered by other precipitants ( P = 0.04). Conclusions AD/ACLF IND , the leading acute precipitant, also plays a role in subsequent AD/ACLF. An abruptly exacerbating, remitting, and relapsing nature of systemic inflammation underlying AD/ACLF may also be useful for risk estimation.
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1371/journal.pone.0250062
- https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0250062&type=printable
- OA Status
- gold
- Cited By
- 7
- References
- 32
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W3156008867
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W3156008867Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1371/journal.pone.0250062Digital Object Identifier
- Title
-
Vulnerability to recurrent episodes of acute decompensation/acute-on-chronic liver failure characterizes those triggered by indeterminate precipitants in patients with liver cirrhosisWork title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2021Year of publication
- Publication date
-
2021-04-13Full publication date if available
- Authors
-
Hitomi Hoshi, Po–Sung Chu, Aya Yoshida, Nobuhito Taniki, Rei Morikawa, Karin Yamataka, Fumie Noguchi, Ryosuke Kasuga, Takaya Tabuchi, Hirotoshi Ebinuma, Hidetsugu Saito, Takanori Kanai∥, Nobuhiro NakamotoList of authors in order
- Landing page
-
https://doi.org/10.1371/journal.pone.0250062Publisher landing page
- PDF URL
-
https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0250062&type=printableDirect link to full text PDF
- Open access
-
YesWhether a free full text is available
- OA status
-
goldOpen access status per OpenAlex
- OA URL
-
https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0250062&type=printableDirect OA link when available
- Concepts
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Decompensation, Cirrhosis, Medicine, Hyponatremia, Gastroenterology, Internal medicine, Indeterminate, Mathematics, Pure mathematicsTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
7Total citation count in OpenAlex
- Citations by year (recent)
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2025: 2, 2024: 1, 2023: 3, 2021: 1Per-year citation counts (last 5 years)
- References (count)
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32Number of works referenced by this work
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-
10Other works algorithmically related by OpenAlex
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| primary_location.landing_page_url | https://doi.org/10.1371/journal.pone.0250062 |
| publication_date | 2021-04-13 |
| publication_year | 2021 |
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