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Thématique :
- Foie
Originalité :
Intermédiaire
Solidité :
Très solide
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2016/10  
 
  2016 Oct;64(4):1249-64  
  doi: 10.1002/hep.28740  
 
  Systemic inflammation in decompensated cirrhosis: Characterization and role in acute-on-chronic liver failure  
 
  Clària J, Stauber RE, Coenraad MJ, Moreau R, Jalan R, Pavesi M, Amorós À, Titos E, Alcaraz-Quiles J, Oettl K, Morales-Ruiz M, Angeli P, Domenicali M, Alessandria C, Gerbes A, Wendon J, Nevens F, Trebicka J, Laleman W, Saliba F, Welzel TM, Albillos A, Gustot T, Benten D, Durand F, Ginès P, Bernardi M, Arroyo V; CANONIC Study Investigators of the EASL-CLIF Consortium and the European Foundation for the Study of Chronic Liver Failure (EF-CLIF).  
  https://www.ncbi.nlm.nih.gov/pubmed/27483394  
 
 

Acute-on-chronic liver failure (ACLF) in cirrhosis is characterized by acute decompensation (AD), organ failure(s), and high short-term mortality. Recently, we have proposed (systemic inflammation [SI] hypothesis) that ACLF is the expression of an acute exacerbation of the SI already present in decompensated cirrhosis. This study was aimed at testing this hypothesis and included 522 patients with decompensated cirrhosis (237 with ACLF) and 40 healthy subjects. SI was assessed by measuring 29 cytokines and the redox state of circulating albumin (HNA2), a marker of systemic oxidative stress. Systemic circulatory dysfunction (SCD) was estimated by plasma renin (PRC) and copeptin (PCC) concentrations. Measurements were performed at enrollment (baseline) in all patients and sequentially during hospitalization in 255. The main findings of this study were: (1) Patients with AD without ACLF showed very high baseline levels of inflammatory cytokines, HNA2, PRC, and PCC. Patients with ACLF showed significantly higher levels of these markers than those without ACLF; (2) different cytokine profiles were identified according to the type of ACLF precipitating event (active alcoholism/acute alcoholic hepatitis, bacterial infection, and others); (3) severity of SI and frequency and severity of ACLF at enrollment were strongly associated. The course of SI and the course of ACLF (improvement, no change, or worsening) during hospitalization and short-term mortality were also strongly associated; and (4) the strength of association of ACLF with SI was higher than with SCD.

CONCLUSION:

These data support SI as the primary driver of ACLF in cirrhosis. (Hepatology 2016;64:1249-1264).

 
Question posée
 
ACLF est-elle bien l’expression de l’exacerbation aiguë de l’inflammation systémique déjà présente chez les patients cirrhotique et peut-elle être évaluée par un profil cytokinique dans le sang périphérique ?
 
Question posée
 
Il existe bien un profil cytokinique associant ACLF à l’inflammation systémique et ce plus fortement qu’au syndrome hyperkinétique avec une corrélation à la mortalité à court terme.
 
Commentaires

Très intéressant mais le coût et la faisabilité des profils cytokiniques ne permettent pas pour l’instant une utilisation en pratique courante.

 
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