CLIF Consortium describes a new syndrome in patients with acute decompensation of cirrhosis

Chronic liver failure is among the top ten causes of death in adults in many countries and constitutes the most common reason for hospital admission amongst all patients with liver diseases. The shortage of liver donors urges the scientific community to design effective treatments for chronic liver failure to improve quality of life and survival in these patients. The EASL-CLIF (European Association for the Study of the Liver – Chronic Liver Failure) consortium is a multicenter organization, coordinated from IDIBAPS – Hospital Clínic of Barcelona by the team led by Dr. Vicente Arroyo and Dr. Pere Ginés, specifically aimed at promoting research projects on Chronic Liver Failure. Recently this Consortium published an article in Gastroenterology, with Dr. Richard Moreau from Hôpital Beaujon (Paris, France) as its first author, describing acute-on-chronic liver failure as a distinct syndrome that develops in patients with acute decompensation of cirrhosis.

Gastreonterology selected the study (1) to be highlighted in a video edited by IDIBAPS – Hospital Clínic Communication Area:

Patients with cirrhosis hospitalized for an acute decompensation and organ failure are at risk for imminent death and considered to have acute-on-chronic liver failure. Investigators of the CANONIC Study, the first study of the EASL–CLIF Consortium, collected data from 1343 hospitalized patients with cirrhosis and acute decompensation at 29 liver units in 8 European countries. The organ failure and mortality data was used to identify diagnostic criteria of acute-on-chronic liver failure and describe the development of this syndrome in European patients with acute decompensation.

Of the patients assessed, 303 had acute-on-chronic liver failure when the study began, 112 developed it, and 928 did not have it. The 28-day mortality rate among patients who had acute-on-chronic liver failure when the study began was 33.9%, among those who developed it was 29.7%, and among those who did not have it was 1.9%. Among other specific characteristics, patients with acute-on-chronic liver failure were younger and more frequently alcoholic, had more associated bacterial infections, and had higher numbers of leukocytes and higher plasma levels of C-reactive protein.

The analyzed data allowed the CLIF Consortium investigators to establish diagnostic criteria for acute-on-chronic liver failure and showed that it is distinct from acute decompensation. This differentiation is based not only on the presence of organ failure(s) and high mortality rate but also on age, precipitating events, and systemic inflammation. An Editorial (2) article published in Gastroenterology together with the commented study states that his information may determine the incidence and outcomes of the patients affected by the newly described syndrome, as well as how data are interpreted to formulate policies and foster future research in this growing field. The editorial also underlines the need to form consortia across geographical regions, and ultimately worldwide, to better understand acute-on-chronic liver failure and its regional differences. The study has also been discussed in a recent Editorial (3) in Nature Reviews Gastroenterology and Hepatology.

References: (1) Moreau R, Jalan R, Gines P, Pavesi M, Angeli P, Cordoba J, Durand F, Gustot T, Saliba F, Domenicali M, Gerbes A, Wendon J, Alessandria C, Laleman W, Zeuzem S, Trebicka J, Bernardi M, Arroyo V; CANONIC Study Investigators of the EASL–CLIF Consortium. Acute-on-Chronic Liver Failure Is a Distinct Syndrome That Develops in Patients With Acute Decompensation of Cirrhosis. Gastroenterology. 2013 Jun;144(7):1426-1437.e9. doi: 10.1053/j.gastro.2013.02.042. Epub 2013 Mar 6. Read The Abstract

(2) Bajaj JS. Defining Acute-on-Chronic Liver Failure: Will East and West Ever Meet? Gastroenterology. 2013 Jun;144(7):1337-9. doi: 10.1053/j.gastro.2013.04.024. Epub 2013 Apr 24. Read The Abstract

(3) Wang FS, Zhang Z. Liver: How can acute-on-chronic liver failure be accurately identified? Nat Rev Gastroenterol Hepatol. 2013 Jul;10(7):390-1. doi: 10.1038/nrgastro.2013.72. Epub 2013 Apr 23. Read The Abstract