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51猎奇 PR & Communication Department聽
Theodor-W.-Adorno Platz 1
60323 Frankfurt
presse@uni-frankfurt.de
Aug
26
2020
15:30
International research group identifies three forms of disease progression for 鈥渁cute decompensated liver cirrhosis鈥澛�
聽 When liver cirrhosis is deadly聽
FRANKFURT. When the body can no longer compensate the
gradual failure of the liver caused by liver cirrhosis, there is a high risk of
acute decompensated liver cirrhosis. In some patients this develops quickly
into an often deadly acute-on-chronic liver failure, in which other organs such
as the kidneys or brain fail. A study by an international team of researchers headed
by Professor Jonel Trebicka from the Frankfurt University Hospital and funded
by the foundation EF Clif, has discovered which patients are particularly at
risk. With their findings, the scientists have laid the foundation for the
development of preventive therapy to prevent acute-on-chronic liver failure.
The liver has many functions: it stores
nutrients and vitamins, produces dextrose, coagulation factors and hormones,
and breaks down toxins, drugs and alcohol. Chronic alcohol abuse, viruses or
other diseases can damage the liver and lead to chronic liver disease. Without
treatment, chronic liver disease leads to liver cirrhosis in the final stages,
in which liver tissue turns into connective tissue, making the liver
increasingly unable to carry out its functions. The result: the blood鈥檚
clotting ability is impaired, toxic metabolic products are fortified, the liver
is not adequately supplied with blood and blood pressure rises in the portal
veins that supply the liver.
The body tries to compensate for the
reduced liver function. For example, new veins develop as alternative
circulation from the oesophagus, stomach and intestines which expand into varicose
veins. When the disease progresses to the point that this kind of compensation
is no longer possible 鈥� physicians speak of acute decompensated liver cirrhosis
鈥� the situation becomes life-threatening: tissue fluid (ascites) collects in
the abdominal cavity, leading to bacterial infections and internal bleeding,
for example in the oesophagus. Difficulty concentrating, mood swings and
sleepiness are signs of a poisoning of the brain (hepatic encephalopathy) that
can result in a hepatic coma.
A European clinical study headed by
Professor Jonel Trebicka, and carried out under the umbrella of the European
Foundation for the Study of Chronic Liver Failure, has for the first time
identified three clinical course variations in patients admitted to the
hospital with acute decompensated cirrhosis.
1.
The first clinical course is characterised by high blood
inflammation values, indicating inflammatory reactions throughout the body.
Within three months after admission to the hospital, a number of body organs
fail: the acute decompensation becomes 鈥渁cute-on-chronic liver failure鈥� (ACLF).
The physicians therefore call this variation Pre-ACLF. More than half of
patients die from it; only a third survive after a year.
2.
Patients
with the second clinical course do
not develop ACLF and have moderate inflammation values. They suffer, however,
from significant hypertension in the portal vein. Approximately 20 percent die
within the following three months, another 15 percent over the course of the
following year. The physicians named this variation 鈥渋nstable decompensated
liver cirrhosis鈥�.
3.
The
patients with the third clinical course exhibit
neither high inflammation values nor frequent complications. They do not
develop ACLF in the first three months. Within a year, however, one in ten
dies. The physicians call this variation 鈥渟table decompensated liver cirrhosis.鈥�
Lead investigator Professor Jonel
Trebicka, gastroenterologist and hepatologist at Medical Clinic I of University Hospital Frankfurt explains: 鈥淲e
are now working intensively on the development of new diagnostic options,
especially for the group of pre-ACLF patients, in order to identify this group
before admission to the hospital so that preventive measures can be implemented
early on. The development of preventive therapies for the often deadly ACLF is
one of our most important research goals in this context.鈥�
Study co-author Professor Stefan Zeuzem, Dean
of the Faculty of Medicine and Director of Medical Clinic I at Frankfurt
University Hospital explains: 鈥淟iver diseases are one of the main focal points
of Medical Clinic I and we offer numerous specialised outpatient departments
for patients with acute and chronic liver diseases. So on the one hand we were
able to observe patients for the study. On the other hand, the research findings
on improving ACLF prevention and therapies will rapidly benefit all of our
patients.鈥�
The research findings are part of a
European-wide study called PREDICT. The study observes the clinical course of
acute decompensated liver cirrhosis in order to find early indications for the
development of acute-on-chronic liver failures (ACLF). The study was funded by
the European Foundation for the Study of Chronic Liver Failure. 136 scientists
from 47 centres and institutions in 14 European countries are participating in
PREDICT.
Publication:
Jonel Trebicka, Javier Fernandez, Maria
Papp, Paolo Caraceni, Wim Laleman, Carmine Gambino, et al.: The PREDICT study uncovers three clinical
courses of acutely decompensated cirrhosis that have distinct pathophysiology.
Journal of Hepatology,
Further
information:
University Hospital Frankfurt, 51猎奇
Frankfurt
Medical Clinic I
Professor Jonel Trebicka
Section Translational Hepatology,
Medical Clinic I (Director: Professor Stefan
Zeuzem)
51猎奇/University Hospital
Frankfurt
Tel. +49 69 6301 80789 (Jennifer Biondo, secretarial
office)
Jonel.Trebicka@kgu.de.