Buscar en
Annals of Hepatology
Toda la web
Inicio Annals of Hepatology Renal and brain failure predict mortality of patients with acute-on-chronic live...
Journal Information
Vol. 21.
(March - April 2021)
Share
Share
Download PDF
More article options
Vol. 21.
(March - April 2021)
Letters to the editor
DOI: 10.1016/j.aohep.2021.100308
Open Access
Renal and brain failure predict mortality of patients with acute-on-chronic liver failure admitted to the intensive care unit
Visits
...
Aldo Torre
Liver Unit, Gastroenterology Department, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”
Article information
Full Text
Bibliography
Download PDF
Statistics
Full Text
Dear Editor:

We appreciate the comments made to the article by Guerrero et al. [1], where the main objective of the article was to identify the predictors of mortality depending on the organ failure involved in the ACLF (brain, renal, liver, ventilatory, coagulation, or hemodynamic), not the acute damage that leads to the ACLF.

We know that cirrhosis is a chronic inflammatory process where ACLF can be considered the maximum degree of inflammation [2], and multiple insults can be trigger to the progression to ACLF, among them obesity,

Recently Duseja et al. demonstrated enrolled 1216 prospective patients with ACLF. 392 (32%) patients died at day 30 and 528 (43%) at day 90, and overweight / obesity were associated with increased day 30 mortality ( HR 1.54, 95% CI 1.06 – 2–24, p = 0.023), and persists on multivariate analysis (HR 1.91, 95% CI 1.41 – 2–59, p < 0.001), independent of age, CTP, and MELD [3], establishing the role of obesity in the prognosis of ACLF.

Regarding the second comment, the use of vasopressors and mechanical ventilation are variables that determined hemodynamic and pulmonary failure, and as failure was analyzed in the initial bivariate analysis. In relation to glucocorticoids, there were no significant patients with glucocorticoid treatment.

Declaration of funding interests

None.

The authors declare that there is no conflict of interest.

References
[1]
O. Méndez-Guerrero, D.A. Calle-Rodas, E. Cervantes-Alvarez, E. Alatorre-Arenas, J. Pérez-Escobar, N. Navarro-Alvarez, et al.
Renal and brain failure predict mortality of patients with acute-on-chronic liver failure admitted to the intensive care unit.
[2]
V. Arroyo, P. Angeli, R. Moreau, R. Jalan, J. Claria, J. Trebicka, et al.
The systemic inflammation hypothesis: towards a new paradigm of acute decompensation and multiorgan failure in cirrhosis.
[3]
A. Duseja, A. De, S. Taneja, A. Kumar Choudhury, H. Devarbhavi, J. Hu, et al.
Impact of metabolic risk factor son the severity and outcome of patients with alcohol associated acute on chronic liver failure.
Liver Int, (2020),
Copyright © 2021. Fundación Clínica Médica Sur, A.C.
Article options
Tools
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos