Stage-specific drivers of clinical progression in advanced chronic liver disease - PubMed
6 hours ago
- #Biomarkers
- #Advanced chronic liver disease
- #Precision medicine
- The study investigated stage-specific drivers of clinical progression in advanced chronic liver disease (ACLD) using a prospective cohort of 464 patients.
- Patients were categorized into clinical states: compensated ACLD (cACLD), first decompensation, further decompensation/ACLF, liver-related death, and recompensation.
- In cACLD patients, 13% developed first decompensation at 24 months, while lower percentages progressed to further decompensation/ACLF or liver-related death.
- In decompensated cirrhosis, 19% progressed to further decompensation/ACLF, and 8% achieved recompensation.
- Among patients with further decompensation at baseline, 33% experienced liver-related death at 12 months.
- Biomarkers including portal hypertension (HVPG), endothelial dysfunction (VWF), liver fibrogenesis (ELF), liver function (MELD/albumin), systemic inflammation (CRP/IL-6), and circulatory dysfunction (proBNP/copeptin) were evaluated.
- Portal hypertension, endothelial dysfunction, fibrogenesis, and impaired liver function were key drivers in cACLD, shifting to systemic inflammation and liver function in decompensated cirrhosis, with circulatory dysfunction added in further decompensation.
- HVPG and albumin provided independent prognostic value in cACLD, CRP in decompensated cirrhosis, and copeptin in further decompensation.
- Targeting portal hypertension is prioritized in cACLD, while modulating systemic inflammation and circulatory dysfunction is crucial in decompensated cirrhosis.
- Precision medicine based on individual biomarker profiles could optimize patient outcomes in future clinical trials.