Acute-on-Chronic Liver Failure on Older Patients -an Overview

Authors

  • Fadhl ALzamili Department of Internal Medicine, College of Medicine, Warith Al-Anbiyaa University, Iraq, Karbala Author

DOI:

https://doi.org/10.59675/M222

Keywords:

Acute, Chronic, Liver, Failure, Older, Patients

Abstract

Acute-onset liver failure (ACLF), a severe manifestation of rapidly decompensating liver fibrosis, was not well reported until 2013. This disease is characterized by a rapid onset of death and failure of the hepatic system. Liver disease is a major cause of death in patients each year. More than 30 million Americans have liver disease, and more than 29 million Americans have chronic liver problems. Age-related changes in the liver include decreased cytochrome P450 activity that can affect drug metabolism and increase susceptibility to drug-induced liver injury, significant reductions in liver volume and blood flow, and decreased immune responses against infection or cancer cells. However, older adults may be more susceptible to autoimmunity due to decreased regulatory T cells and impaired maturation of dendritic cells. Because of changes in the liver, patients with liver disorders may experience a variety of clinical manifestations and outcomes. The pathophysiology of viral hepatitis, autoimmune liver disorders, and the onset of hepatocellular carcinoma may be influenced by these changes in immune function. Furthermore, treatment of liver disease is less appropriate for elderly patients due to the significantly reduced reserve functions of many organs. Age-related changes in the liver and other organs may have an impact on the treatment course and clinical features of liver disease in the elderly. An overwhelming systemic inflammatory response caused by clinically obvious etiological factors (such as confirmed microbiological infection associated with sepsis or severe alcohol-related hepatitis) or clinically unclear causes acute-chronic liver failure. Following the classification of acute-chronic liver failure (ACLF), several important studies have shown that patients with this condition should be stabilized as soon as possible in order to potentially benefit from liver transplantation. Receive comprehensive general care, which includes appropriate treatment in the intensive care unit and support of organ systems in the identified etiological factors.

References

Alam A, Suen KC, Ma D. Acute-on-chronic liver failure: recent update. Journal of biomedical research. 2017;31(4):283.

Lee WM, Stravitz RT, Larson AM. Introduction to the revised American Association for the Study of Liver Diseases Position Paper on acute liver failure 2011[J]. Hepatology, 2012, 55(3): 965–967.

Asrani SK, Kamath PS. Natural history of cirrhosis. Curr Gastroenterol Rep 2013; 15: 308 [PMID: 23314828 DOI: 10.1007/ s11894-012-0308-y]

Jalan R, Gines P, Olson JC, Mookerjee RP, Moreau R, GarciaTsao G, Arroyo V, Kamath PS. Acute-on chronic liver failure. J Hepatol 2012; 57: 1336-1348 [PMID: 22750750 DOI: 10.1016/¬j. jhep.2012.06.026]

Moreau R, Arroyo V. Acute-on-chronic liver failure: a new clinical entity. Clin Gastroenterol Hepatol 2015; 13: 836-841 [PMID: 24583872 DOI: 10.1016/j.cgh.2014.02.027]

World Health Organization. Projections of mortality and burden of disease to 2030 www.who.int/healthinfo/statistics/ bodprojections2030/en/index.html

Moreau R, Jalan R, Ginès P, Pavesi M, Angeli P, Cordoba J, et al. Acute-onchronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology 2013;144:1426– 1437

Arroyo V, Moreau R, Jalan R. Acute-on-chronic liver failure. N Engl J Med 2020;382:2137–2145.

Moreau R, Jalan R, Ginès P, Pavesi M, Angeli P, Cordoba J, et al. Acute-onchronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology 2013;144:1426– 1437.

Bajaj JS, O’Leary JG, Reddy KR, Wong F, Biggins SW, Patton H, et al. Survival in infection-related acute-on-chronic liver failure is defined by extrahepatic organ failures. Hepatology 2014;60:250–256.

Wu T, Li J, Shao L, Xin J, Jiang L, Zhou Q, et al., on behalf of the Chinese Group on the Study of Severe Hepatitis B (COSSH). Development of diagnostic criteria and a prognostic score for hepatitis B virus-related acute-on-chronic liver failure. Gut 2018;67:2181–2191.

Sarin SK, Choudhury A, Sharma MK, Maiwall R, Al Mahtab M, Rahman S, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL): an update. Hepatol Int 2019;13:353–390.

Lopez-Otín, ´ C., Blasco, M.A., Partridge, L., Serrano, M., Kroemer, G., 2023. Hallmarks of aging: an expanding universe. Cell. 186 (2), 243–278.

Schmucker, D.L., 2005. Age-related changes in liver structure and function: implications for disease ? Exp. Gerontol. 40, 650–659.

Grizzi, F., Di Caro, G., Laghi, L., Hermonat, P., Mazzola, P., Nguyen, D.D., Radhi, S., Figueroa, J.A., Cobos, E., Annoni, G., Chiriva-Internati, M., 2013. Mast cells and the liver aging process. Immun. Ageing 10, 9

Fortea, J.I., Crespo, J., Puente, A., 2022. Cirrhosis, a global and challenging disease. J. Clin. Med. 11

Younossi, Z.M., 2019. Non-alcoholic fatty liver disease – a global public health perspective. J. Hepatol. 70, 531–544.

Rinella ME, Lazarus JV, Ratziu V, Francque SM, Sanyal AJ, Kanwal F, Romero D, Abdelmalek MF, Anstee QM, Arab JP, Arrese M. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology. 2023 Dec 1;78(6):1966-86.https://doi.org/10.1097/HEP.0000000000000520

Schmucker DL. Age-related changes in liver structure and function: implications for disease? Exp Gerontol. 2005; 40:650–659. [PubMed: 16102930]

Le Couteur DG, Warren A, Cogger VC, et al. Old age and the hepatic sinusoid. Anat Rec (Hoboken). 2008; 291:672–683. [PubMed: 18484614]

Floreani A. Liver diseases in the elderly: an update. Dig Dis. 2007; 25:138–143. [PubMed: 17468549]

Amarapurkar D, Kamani P, Patel N, et al. Prevalence of nonalcoholic fatty liver disease: population based study. Ann Hepatol. 2007; 6:161–163. [PubMed: 17786142]

Sheedfar F, Di Biase S, Koonen D, Vinciguerra M. Liver diseases and aging: friends or foes? Aging Cell. 2013; 12:950–954. [PubMed: 23815295] The authors review the effect of aging on liver diseases and argue that there might be an age window in which the liver becomes resistant to the development of injury

Schmucker DL. Age-related changes in liver structure and function: implications for disease? Exp Gerontol. 2005; 40:650–659. [PubMed: 16102930]

Wakabayashi H, Nishiyama Y, Ushiyama T, et al. Evaluation of the effect of age on functioning hepatocyte mass and liver blood flow using liver scintigraphy in preoperative estimations for surgical patients: comparison with CT volumetry. J Surg Res. 2002; 106:246–253. [PubMed: 12175974]

Schmucker DL, Sachs H. Quantifying dense bodies and lipofuscin during aging: a morphologist’s perspective. Arch Gerontol Geriatr 2002; 34: 249-261 [PMID: 14764327 DOI: 10.1016/S0167-4943(01)00218-7]

Al-Chalabi T, Boccato S, Portmann BC, McFarlane IG, Heneghan MA. Autoimmune hepatitis (AIH) in the elderly: a systematic retrospective analysis of a large group of consecutive patients with definite AIH followed at a tertiary referral centre. J Hepatol 2006; 45: 575-583 [PMID: 16899323 DOI: 10.1016/j.jhep.2006.04.007]

Talwalkar JA, Lindor KD. Primary biliary cirrhosis. Lancet 2003; 362: 53-61 [PMID: 12853201 DOI: 10.1016/S0140- 6736(03)¬13808-1]

Wiesner RH, Grambsch PM, Dickson ER, Ludwig J, MacCarty RL, Hunter EB, Fleming TR, Fisher LD, Beaver SJ, LaRusso NF. Primary sclerosing cholangitis: natural history, prognostic factors and survival analysis. Hepatology 1989; 10: 430-436 [PMID: 2777204 DOI: 10.1002/hep.1840100406]

Manka P, Verheyen J, Gerken G, Canbay A. Liver Failure due to Acute Viral Hepatitis (A-E). Visc Med 2016; 32: 80-85 [PMID: 27413724 DOI: 10.1159/000444915]

Brown GR, Persley K. Hepatitis A epidemic in the elderly. South Med J 2002; 95: 826-833 [PMID: 12190216]

Willner IR, Uhl MD, Howard SC, Williams EQ, Riely CA, Waters B. Serious hepatitis A: an analysis of patients hospitalized during an urban epidemic in the United States. Ann Intern Med 1998; 128: 111-114 [PMID: 9441570 DOI: 10.7326/ 0003-4819-128-2-199801150-00006]

Nguyen, M.H.; Wong, G.; Gane, E.; Kao, J.H.; Dusheiko, G. Hepatitis B Virus: Advances in Prevention, Diagnosis, and Therapy. Clin. Microbiol. Rev. 2020, 33. [CrossRef]

Rybicka, M.; Bielawski, K.P. Recent Advances in Understanding, Diagnosing, and Treating Hepatitis B Virus Infection. Microorganisms 2020, 8, 1416. [CrossRef]

Stanaway, J.D.; Flaxman, A.D.; Naghavi, M.; Fitzmaurice, C.; Vos, T.; Abubakar, I.; Abu-Raddad, L.J.; Assadi, R.; Bhala, N.; Cowie, B.; et al. The global burden of viral hepatitis from 1990 to 2013: Findings from the Global Burden of Disease Study 2013. Lancet 2016, 388, 1081–1088. [CrossRef]

World Health Organization. Global Hepatitis Report 2017; WHO: Geneva, Switzerland, 2017.

Michielsen, P.; Ho, E. Viral hepatitis B and hepatocellular carcinoma. Acta Gastro-Enterol. Belg. 2011, 74, 4–8.

World Health Organization. Hepatitis B and Hepatitis C. WHO bulletin 24 June 2022. [cited 30 June 2022]. In: World Health Organization [Internet]. Available from: www.who.in/Factsheets/Detail/Hepatitis

Nielsen S, Hansen JF, Hay G, Cowan S, Jepsen P, Omland LH, Krarup HB, Søholm J, Lazarus JV, Weis N, vrehus A, Christensen PB. Hepatitis C prevalence in Denmark in 2016-An updated estimate using multiple national registers. PLoS One 2020; 15: e0238203 [PMID: 32881877 DOI: 10.1371/journal.pone.0238203]

Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhnert WL, Alter MJ. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med 2006; 144: 705-714 [PMID: 16702586 DOI: 10.7326/0003-4819- 144-10-200605160-00004]

Mindikoglu AL, Miller RR. Hepatitis C in the elderly: epidemiology, natural history, and treatment. Clin Gastroenterol Hepatol 2009; 7: 128-134; quiz 124 [PMID: 19084480 DOI: 10.1016/j.cgh.2008.07.017]

Honda T, Katano Y, Urano F, Murayama M, Hayashi K, Ishigami M, Nakano I, Yoshioka K, Toyoda H, Kumada T, Goto H. Efficacy of ribavirin plus interferon-alpha in patients aged > or=60 years with chronic hepatitis C. J Gastroenterol Hepatol 2007; 22: 989-995 [PMID: 17608843 DOI: 10.1111/ j.1440-1746.2006.04773.x]

Floreani A, Minola E, Carderi I, Ferrara F, Rizzotto ER, Baldo V. Are elderly patients poor candidates for pegylated interferon plus ribavirin in the treatment of chronic hepatitis C? J Am Geriatr Soc 2006; 54: 549-550 [PMID: 16551333 DOI: 10.1111/j.1532-5415.2006.00643_4.x]

Hoofnagle JH, Nelson KE, Purcell RH. Hepatitis E. N Engl J Med 2012; 367: 1237-1244 [PMID: 23013075 DOI: 10.1056/NEJMra1204512]

Krawczynski K. Foreword. Hepatitis E virus. Semin Liver Dis 2013; 33: 1-2 [PMID: 23564384 DOI: 10.1055/s-0033-1338119]

Chandra NS, Sharma A, Malhotra B, Rai RR. Dynamics of HEV viremia, fecal shedding and its relationship with transaminases and antibody response in patients with sporadic acute hepatitis E. Virol J 2010; 7: 213 [PMID: 20815928 DOI: 10.1186/1743-422X-7-213]

Guerra JAAA, Kampa KC, Morsoletto DGB, Junior AP, Ivantes CAP. Hepatitis E: A Literature Review. J Clin Transl Hepatol 2017; 5: 376-383 [PMID: 29226104 DOI: 10.14218/JCTH.2017.00012]

Balayan MS, Andjaparidze AG, Savinskaya SS, Ketiladze ES, Braginsky DM, Savinov AP, Poleschuk VF. Evidence for a virus in non-A, non-B hepatitis transmitted via the fecal-oral route. Intervirology 1983; 20: 23-31 [PMID: 6409836 DOI: 10.1159/000149370]

Al-Chalabi T, Boccato S, Portmann BC, McFarlane IG, Heneghan MA. Autoimmune hepatitis (AIH) in the elderly: a systematic retrospective analysis of a large group of consecutive patients with definite AIH followed at a tertiary referral centre. J Hepatol 2006; 45: 575-583 [PMID: 16899323DOI: 10.1016/j.jhep.2006.04.007]

Talwalkar JA, Lindor KD. Primary biliary cirrhosis. Lancet 2003; 362: 53-61 [PMID: 12853201 DOI: 10.1016/S0140- 6736(03)¬13808-1]

Wiesner RH, Grambsch PM, Dickson ER, Ludwig J, MacCarty RL, Hunter EB, Fleming TR, Fisher LD, Beaver SJ, LaRusso NF. Primary sclerosing cholangitis: natural history, prognostic factors and survival analysis. Hepatology 1989; 10: 430-436 [PMID: 2777204 DOI: 10.1002/hep.1840100406]

Zeng N, Duan W, Chen S, Wu S, Ma H, Ou X, et al. Epidemiology and clinical course of primary biliary cholangitis in the Asia-Pacific region: a systematic review and meta-analysis. Hepatol Int 2019;13(6):788–799. doi:10.1007/ s12072-019-09984-x, PMID:31552558.

Dyson JK, Blain A, Foster Shirley MD, Hudson M, Rushton S, Jeffreys Jones DE. Geo-epidemiology and environmental co-variate mapping of primary biliary cholangitis and primary sclerosing cholangitis. JHEP Rep 2021;3(1):100202. doi:10.1016/j.jhepr.2020.100202, PMID:33474546.

Matsumoto K, Ohfuji S, Abe M, Komori A, Takahashi A, Fujii H, et al. Environmental factors, medical and family history, and comorbidities associated with primary biliary cholangitis in Japan: a multicenter case-control study. J Gastroenterol 2022;57(1):19–29. doi:10.1007/s00535-021-01836-6, PMID:34796398.

Prince MI, Ducker SJ, James OF. Case-control studies of risk factors for primary biliary cirrhosis in two United Kingdom populations. Gut 2010; 59(4):508–512. doi:10.1136/gut.2009.184218, PMID:20332522.

Wijarnpreecha K, Werlang M, Panjawatanan P, Kroner PT, Mousa OY, Pungpapong S, et al. Association between Smoking and Risk of Primary Biliary Cholangitis: A Systematic Review and Meta-Analysis. J Gastrointestin Liver Dis 2019;28:197–203. doi:10.15403/jgld-181, PMID:31204401.

Mayo MJ. Natural history of primary biliary cirrhosis. Clin Liver Dis 2008;12(2):277–288. doi:10.1016/j.cld.2008.02.012, PMID:18456180.

Parés A, Caballería L, Rodés J. Excellent long-term survival in patients with primary biliary cirrhosis and biochemical response to ursodeoxycholic Acid. Gastroenterology 2006;130(3):715–720. doi:10.1053/j.gastro.2005.12.029, PMID:16530513.

Harms MH, van Buuren HR, Corpechot C, Thorburn D, Janssen HLA, Lindor KD, et al. Ursodeoxycholic acid therapy and liver transplant-free survival in patients with primary biliary cholangitis. J Hepatol 2019;71(2):357–365. doi:10.1016/j.jhep.2019.04.001, PMID:30980847

Singal AG, Lampertico P, Nahon P. Epidemiology and surveillance for hepatocellular carcinoma: New trends. J Hepatol 2020;72:250-261.

Liu Z, Suo C, Mao X, Jiang Y, Jin L, Zhang T, et al. Global incidence trends in primary liver cancer by age at diagnosis, sex, region, and etiology, 1990-2017. Cancer 2020;126:2267-2278.

Dasgupta P, Henshaw C, Youlden DR, Clark PJ, Aitken JF, Baade PD. Global trends in incidence rates of primary adult liver cancers: a systematic review and meta-analysis. Front Oncol 2020;10:171.

Bertuccio P, Turati F, Carioli G, Rodriguez T, La Vecchia C, Malvezzi M, et al. Global trends and predictions in hepatocellular carcinoma mortality. J Hepatol 2017;67:302-309

Liver Cancer Survival Rates. American Cancer Society. https:// www.cancer.org/cancer/liver-cancer/detection-diagnosis-staging/ survival-rates.html. [Accessed May 21, 2020].

Robinson A, Tavakoli H, Liu B, Bhuket T, Wong RJ. Advanced hepatocellular carcinoma tumor stage at diagnosis in the 1945- 1965 birth cohort reflects poor use of hepatocellular carcinoma screening. Hepatol Commun 2018;2:1147-1155.

Park J, Chen M, Colombo M, Roberts LR, Schwartz M, Chen P, et al. Global patterns of hepatocellular carcinoma management from diagnosis to death: the BRIDGE Study. Liver Int 2015;35:2155-2166.

Adeniji N, Dhanasekaran R. Genomic Landscape of HCC. Curr Hepatol Rep 2020;19:448-461.

Farazi PA, DePinho RA. Hepatocellular carcinoma pathogenesis: from genes to environment. Nat Rev Cancer 2006;6:674-687.

Llovett JM, Zucman-Rossi J, Pikarsky E, et al. Hepatocellular carcinoma. Nat Rev Dis Primers 2016;2:16018.

European Association for the Study of the Liver. European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol 2018; 69: 406-460 [PMID: 29653741 DOI: 10.1016/j.jhep.2018.03.024]

Oscanoa TJ, Lizaraso F, Carvajal A. Hospital admissions due to adverse drug reactions in the elderly. A meta-analysis. Eur J Clin Pharmacol 2017; 73: 759-770 [PMID: 28251277 DOI: 10.1007/s00228-017-2225-3]

de Franchis R; Baveno VI Faculty. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol 2015; 63: 743-752 [PMID: 26047908 DOI: 10.1016/j.jhep.2015.05.022]

Lenti MV, Pasina L, Cococcia S, Cortesi L, Miceli E, Caccia Dominioni C, Pisati M, Mengoli C, Perticone F, Nobili A, Di Sabatino A, Corazza GR; REPOSI Investigators. Mortality rate and risk factors for gastrointestinal bleeding in elderly patients. Eur J Intern Med 2019; 61: 54-61 [PMID: 30522789 DOI: 10.1016/j.ejim.2018.11.003]

Bajaj JS, Ratliff SM, Heuman DM, Lapane KL. Proton pump inhibitors are associated with a high rate of serious infections in veterans with decompensated cirrhosis. Aliment Pharmacol Ther 2012; 36: 866-874 [PMID: 22966967 DOI: 10.1111/apt.12045]

Freedberg DE, Kim LS, Yang YX. The Risks and Benefits of Long-term Use of Proton Pump Inhibitors: Expert Review and Best Practice Advice From the American Gastroenterological Association. Gastroenterology 2017; 152: 706-715 [PMID: 28257716 DOI: 10.1053/j.gastro.2017.01.031]

Tsai CF, Chen MH, Wang YP, Chu CJ, Huang YH, Lin HC, Hou MC, Lee FY, Su TP, Lu CL. Proton Pump Inhibitors Increase Risk for Hepatic Encephalopathy in Patients With Cirrhosis in A Population Study. Gastroenterology 2017; 152: 134-141 [PMID: 27639806 DOI: 10.1053/j.gastro.2016.09.007]

Guirguis J, Chhatwal J, Dasarathy J, Rivas J, McMichael D, Nagy LE, et al. Clinical impact of alcohol-associated cirrhosis in the next decade: estimates based on current epidemiological trends in the United States. Alcohol Clin Exp Res 2015;39:2085-2094.

Tapper EB, Parikh ND. Mortality due to cirrhosis and liver cancer in the United States, 1999–2016: observational study. BMJ 2018;362:k2817.

Case A, Deaton A. Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proc Natl Acad Sci USA 2015;112:15078-15083.

Lieber SR, Rice JP, Lucey MR, Bataller R. Controversies in clinical trials for alcoholic hepatitis. J Hepatol 2018;68:586-592.

Rambaldi A, Saconato HH, Christensen E, Thorlund K, Wetterslev J, Gluud C. Systematic review: glucocorticosteroids for alcoholic hepatitis—a Cochrane Hepato-Biliary Group systematic review with meta-analyses and trial sequential analyses of randomized clinical trials. Aliment Pharmacol Ther 2008;27:1167-1178.

Christensen E, Gluud C. Glucocorticoids are ineffective in alcoholic hepatitis: a meta-analysis adjusting for confounding variables. Gut 1995;37:113-118.

summarizes current theories about the etiology of both acute and chronic liver failure in relation to alcohol-related liver disease

Published

25-08-2024

Issue

Section

Articles

How to Cite

Fadhl ALzamili. (2024). Acute-on-Chronic Liver Failure on Older Patients -an Overview. Academic International Journal of Medical Sciences , 2(2), 09-11. https://doi.org/10.59675/M222