Recent Advances in the Prevention and Treatment of Decompensated Cirrhosis and Acute-on-Chronic Liver Failure (ACLF) and the Role of Biomarkers

Authors

Jonel Trebicka
Ruben Hernaez
Debbie Lindsay Shawcross
Alexander L Gerbes

Publication Date

5-10-2024

Journal

Gut

DOI

10.1136/gutjnl-2023-330584

PMID

38527788

PMCID

PMC11103292

PubMedCentral® Posted Date

5-25-2024

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Humans, Acute-On-Chronic Liver Failure, Liver Cirrhosis, Biomarkers, Disease Progression, Hypertension, Portal, Gastrointestinal Microbiome, Bacterial Translocation, liver failure, cirrhosis, clinical decision making

Abstract

The progression of cirrhosis with clinically significant portal hypertension towards decompensated cirrhosis remains clinically challenging and the evolution towards acute-on-chronic liver failure (ACLF), with one or more extrahepatic organ failures, is associated with very high mortality. In the last decade, significant progress has been made in the understanding of the mechanisms leading to decompensation and ACLF. As portal hypertension advances, bacterial translocation across an impaired gut barrier culminates in endotoxaemia, systemic inflammation and cirrhosis-associated immune dysfunction (CAID). Gut-derived systemic inflammation and CAID have become the logical targets for innovative therapies that prevent hepatic decompensation episodes and the progression to ACLF.Furthermore, classification of disease and biomarker discovery to personalise care have advanced in the field. This review discusses progress in biomarker discovery and personalisation of treatment in decompensated cirrhosis and ACLF.

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