TY  - JOUR
A1  - Praktiknjo, Michael
A1  - Monteiro, Sofia
A1  - Grandt, Josephine
A1  - Kimer, Nina
A1  - Madsen, Jan L.
A1  - Werge, Mikkel P.
A1  - William, Peter
A1  - Brol, Maximilian
A1  - Turco, Laura
A1  - Schierwagen, Robert
A1  - Chang, Johannes
A1  - Klein, Sabine
A1  - Uschner, Frank Erhard
A1  - Welsch, Christoph
A1  - Moreau, Richard
A1  - Schepis, Filippo
A1  - Bendtsen, Flemming
A1  - Gluud, Lise L.
A1  - Møller, Søren
A1  - Trebicka, Jonel
T1  - Cardiodynamic state is associated with systemic inflammation and fatal acute‐on‐chronic liver failure
T2  - Liver international
N2  - Background & Aims: Acute‐on‐chronic liver failure (ACLF) is characterized by high short‐term mortality and systemic inflammation (SI). Recently, different cardiodynamic states were shown to independently predict outcomes in cirrhosis. The relationship between cardiodynamic states, SI, and portal hypertension and their impact on ACLF development remains unclear. The aim of this study was therefore to evaluate the interplay of cardiodynamic state and SI on fatal ACLF development in cirrhosis.
Results: At inclusion, hemodynamic measures including cardiac index (CI) and hepatic venous pressure gradient of 208 patients were measured. Patients were followed prospectively for fatal ACLF development (primary endpoint). SI was assessed by proinflammatory markers such as interleukins (ILs) 6 and 8 and soluble IL‐33 receptor (sIL‐33R). Patients were divided according to CI (<3.2; 3.2‐4.2; >4.2 L/min/m2) in hypo‐ (n = 84), normo‐ (n = 69) and hyperdynamic group (n = 55). After a median follow‐up of 3 years, the highest risk of fatal ACLF was seen in hyperdynamic (35%) and hypodynamic patients (25%) compared with normodynamic (14%) (P = .011). Hyperdynamic patients showed the highest rate of SI. The detectable level of IL‐6 was an independent predictor of fatal ACLF development.
Conclusions: Cirrhotic patients with hyperdynamic and hypodynamic circulation have a higher risk of fatal ACLF. Therefore, the cardiodynamic state is strongly associated with SI, which is an independent predictor of development of fatal ACLF.
KW  - acute‐on‐chronic liver failure
KW  - circulation
KW  - cirrhosis
KW  - hemodynamic
KW  - inflammation
Y1  - 2020
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/56064
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-560642
SN  - 1478-3231
VL  - 40
IS  - 6
SP  - 1457
EP  - 1466
PB  - Wiley-Blackwell
CY  - Oxford
ER  -