Michael Praktiknjo1, Sofia Monteiro1,2, Josephine Grandt3, Nina Kimer3, Jan L Madsen4, Mikkel P Werge3, Peter William3, Maximilian J Brol1, Laura Turco5, Robert Schierwagen6, Johannes Chang1, Sabine Klein6, Frank E Uschner6, Christoph Welsch6, Richard Moreau7,8, Filippo Schepis5, Flemming Bendtsen3, Lise L Gluud3, Søren Møller4, Jonel Trebicka6,9,10,11. 1. Department of Internal Medicine I, University of Bonn, Bonn, Germany. 2. Department of Medicine, Hospital Pedro Hispano, Matosinhos, Portugal. 3. Gastrounit Medical Division, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark. 4. Department of Clinical Physiology and Nuclear Medicine, 239 Center for Functional and Diagnostic Imaging and Research, Faculty of Health Sciences Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark. 5. Division of Gastroenterology, Azienda Ospedaliero-Universitaria di Modena and University of Modena and Reggio Emilia, Modena, Italy. 6. Department of Internal Medicine I, J.W.Goethe University Hospital, Frankfurt, Germany. 7. Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon, Département Hospitalo-Universitaire UNITY, Clichy, France. 8. Centre de Recherche sur l'Inflammation, Unité Mixte de Recherche, Institut National de la Santé et de la Recherche Médicale and Université Paris Diderot, Paris, France. 9. European Foundation for Study of Chronic Liver Failure, Barcelona, Spain. 10. Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark. 11. Institute of Bioengineering Catalunya, Barcelona, Spain.
Abstract
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.
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.
Authors: Michael Praktiknjo; Jasmin Abu-Omar; Johannes Chang; Daniel Thomas; Christian Jansen; Patrick Kupczyk; Filippo Schepis; Juan Carlos Garcia-Pagan; Manuela Merli; Carsten Meyer; Christian P Strassburg; Claus C Pieper; Jonel Trebicka Journal: JHEP Rep Date: 2021-03-03
Authors: Alexander Queck; Frank E Uschner; Philip G Ferstl; Martin Schulz; Maximilian J Brol; Michael Praktiknjo; Robert Schierwagen; Sabine Klein; Christian P Strassburg; Carsten Meyer; Christian Jansen; Marie-Luise Berres; Jonel Trebicka Journal: PLoS One Date: 2021-08-25 Impact factor: 3.240
Authors: Johannes Chang; Avend Bamarni; Nina Böhling; Xin Zhou; Leah-Marie Klein; Jonathan Meinke; Georg Daniel Duerr; Philipp Lingohr; Sven Wehner; Maximilian J Brol; Jürgen K Rockstroh; Jörg C Kalff; Steffen Manekeller; Carsten Meyer; Ulrich Spengler; Christian Jansen; Vicente Arroyo; Christian P Strassburg; Jonel Trebicka; Michael Praktiknjo Journal: Hepatol Commun Date: 2021-03-26
Authors: Michael Praktiknjo; Robert Schierwagen; Sofia Monteiro; Cristina Ortiz; Frank Erhard Uschner; Christian Jansen; Joan Claria; Jonel Trebicka Journal: Gut Date: 2020-10-21 Impact factor: 23.059
Authors: Jonel Trebicka; Wenyi Gu; Victor de Ledinghen; Christophe Aubé; Aleksander Krag; Michael Praktiknjo; Laurent Castera; Jerome Dumortier; David Josef Maria Bauer; Mireen Friedrich-Rust; Stanislas Pol; Ivica Grgurevic; Rongqin Zheng; Sven Francque; Halima Gottfriedovà; Sanda Mustapic; Ioan Sporea; Annalisa Berzigotti; Frank Erhard Uschner; Benedikt Simbrunner; Maxime Ronot; Christophe Cassinotto; Maria Kjaergaard; Filipe Andrade; Martin Schulz; Georg Semmler; Ida Tjesic Drinkovic; Johannes Chang; Maximilian Joseph Brol; Pierre Emmanuel Rautou; Thomas Vanwolleghem; Christian P Strassburg; Jerome Boursier; Philip Georg Ferstl; Ditlev Nytoft Rasmussen; Thomas Reiberger; Valerie Vilgrain; Aymeric Guibal; Olivier Guillaud; Stefan Zeuzem; Camille Vassord; Xue Lu; Luisa Vonghia; Renata Senkerikova; Alina Popescu; Cristina Margini; Wenping Wang; Maja Thiele; Chrisitan Jansen Journal: Gut Date: 2021-01-21 Impact factor: 23.059