Systemic Inflammation and Acute-on-Chronic Liver Failure: Too Much, Not Enough. (1st August 2018)

• Record Type: Journal Article
• Authors: Laleman, Wim; Claria, Joan; Van der Merwe, Schalk; Moreau, Richard; Trebicka, Jonel
• Other Names: Fan Yu-Chen Academic Editor.
• Is Part Of: Canadian journal of gastroenterology & hepatology. Volume 2018(2018)
• Publication Date: 2018-08-01
• Subjects: Digestive organs -- Diseases -- Periodicals; Gastroenterology -- Periodicals; Digestive organs -- Diseases; Gastroenterology; Canada; Digestive System Diseases -- Periodicals; Gastroenterology -- Periodicals; Periodicals; Electronic journals; Fulltext; Internet Resources; Periodicals; 616.3
• DOI: 10.1155/2018/1027152
• Languages: English
• ISSNs: 2291-2789

Abstract

Abstract : ACLF is a specific, but complex and multifactorial form of acute decompensation of cirrhosis and is characterized by an extraordinary dynamic natural course, rapidly evolving organ failure, and high short-term mortality. Dysbalanced immune function is central to its pathogenesis and outcome with an initial excessive systemic inflammatory response that drives organ failure and mortality. Later in its course, immuno-exhaustion/immunoparalysis prevails predisposing the patient to secondary infectious events and reescalation in end-organ dysfunction and mortality. The management of patients with ACLF is still poorly defined. However, as its pathophysiology is gradually being unravelled, potential therapeutic targets emerge that warrant further study such as restoring or substituting albumin via plasma exchange or via albumin dialysis and evaluating usefulness of TLR4 antagonists, modulators of gut dysbiosis (pre- or probiotics), and FXR-agonists.