Rapid progression or aggravation of jaundice, coagulation abnormalities and liver-related complications in patients with alcoholichepatitis indicates that they may develop severe alcoholic hepatitis. Some of these patients can progress acute-on-chronic liver failure withacute insults, such as infection and binge drinking and binge, showing as acute decompensation, organ failure and high 28-day mortalityrate. Early identification and effective intervention can improve the prognosis of acute-on-chronic liver failure. Intestinal barrier dysfunc-tion and liver-gut axis imbalance play an important role in the development of severe alcoholic hepatitis and acute-on-chronic liver fail-ure. It is important to improve the basic nutritional status of patients. Effective drug therapies are limited in improving the condition andprognosis of acute-on-chronic liver failure. Early liver transplantation can bring great benefits to these patients.
[1] SINGAL AK, BATALLER R, AHN J, et al. ACG clinical guide-line:Alcoholic liver disease[J]. Am J Gastroenterol, 2018, 113 (2) :175-194.
|
[2] GUSTOT T, JALAN R. Acute-on-chronic liver failure in pa-tients with alcohol-related liver disease[J]. J Hepatol, 2019, 70 (2) :319-327.
|
[3] JEONG JH, PARK IS, KIM DH, et al. CLIF-SOFA score andSIRS are independent prognostic factors in patients with hepat-ic encephalopathy due to alcoholic liver cirrhosis[J]. Medi-cine, 2016, 95 (26) :e3935.
|
[4] MOREAU R, JALAN R, GINES P, et al. Acute-on-chronicliver failure is a distinct syndrome that develops in patients withacute decompensation of cirrhosis[J]. Gastroenterology, 2013, 144 (7) :1426-1437.
|
[5] SARIN SK, KEDARISETTY CK, ABBAS Z, et al. Acute-on-chronic liver failure:Consensus recommendations of the AsianPacific Association for the Study of the Liver (APASL) 2014[J]. Hepatol Int, 2014, 8 (4) :453-471.
|
[6] SARIN SK, KUMAR A, ALMEIDA JA, et al. Acute-on-chro-nic liver failure:Consensus recommendations of the Asian Pa-cific Association for the study of the liver (APASL) [J]. Hepa-tol Int, 2009, 3 (1) :269-282.
|
[7] WEICHSELBAUM L, GUSTOT T. The organs in acute-on-chronic liver failure[J]. Semin Liver Dis, 2016, 36 (2) :174-180.
|
[8] SZABO G. More than meets the eye:Severe alcoholic hepati-tis can present as acute-on-chronic liver failure[J]. J Hep-atol, 2018, 69 (2) :269-271.
|
[9] SERSTE T, CORNILLIE A, NJIMI H, et al. The prognostic val-ue of acute-on-chronic liver failure during the course of se-vere alcoholic hepatitis[J]. J Hepatol, 2018, 69 (2) :318-324.
|
[10] LEE M, LEE JH, OH S, et al. CLIF-SOFA scoring system ac-curately predicts short-term mortality in acutely decompen-sated patients with alcoholic cirrhosis:A retrospective analysis[J]. Liver Int, 2015, 35 (1) :46-57.
|
[11] DHIMAN RK, AGRAWAL S, GUPTA T, et al. Chronic liver fail-ure-sequential organ failure assessment is better than the A-sia-Pacific Association for the Study of Liver criteria for defi-ning acute-on-chronic liver failure and predicting outcome[J]. World J Gastroenterol, 2014, 20 (40) :14934-14941.
|
[12] YELURU A, CUTHBERT JA, CASEY L, et al. Alcoholic hepati-tis:Risk factors, pathogenesis, and approach to treatment[J]. Alcohol Clin Exp Res, 2016, 40 (2) :246-255.
|
[13] LI XJ, MU Y, QIN QF, et al. Chronic high-dosage fish oilexacerbates gut-liver axis injury in alcoholic steatohepatitisin mice:The roles of endotoxin and IL-4 in Kupffer cell po-larization imbalance[J]. Toxicol Res (Camb) , 2017, 6 (5) :611-620.
|
[14] ELAMIN EE, MASCLEE AA, DEKKER J, et al. Ethanol metab-olism and its effects on the intestinal epithelial barrier[J]. NutrRev, 2013, 71 (7) :483-499.
|
[15] CHO YE, YU LR, ABDELMEGEED M, et al. Apoptosis of en-terocytes and nitration of junctional complex proteins promotealcohol-induced gut leakiness and liver injury[J]. J Hepatol, 2018, 69 (1) :142-153.
|
[16] SHAO T, ZHAO C, LI F, et al. Intestinal HIF-1αdeletion ex-acerbates alcoholic liver disease by inducing intestinal dysbio-sis and barrier dysfunction[J]. J Hepatol, 2018, 69 (4) :886-895.
|
[17] CHEN Y, GUO J, QIAN G, et al. Gut dysbiosis in acute-on-chronic liver failure and its predictive value for mortality[J].J Gastroenterol Hepatol, 2015, 30 (9) :1429-1437.
|
[18] YANG AM, INAMINE T, HOCHRATH K, et al. Intestinal fungicontribute to development of alcoholic liver disease[J]. J ClinInvest, 2017, 127 (7) :2829-2841.
|
[19] LALEMAN W, CLARIA J, van der MERWE S, et al. Systemicinflammation and acute-on-chronic liver failure:Too much, not enough[J]. Can J Gastroenterol Hepatol, 2018, 2018:1027152.
|
[20] NEAL MD, LEAPHART C, LEVY R, et al. Enterocyte TLR4 me-diates phagocytosis and translocation of bacteria across theintestinal barrier[J]. J Immunol, 2006, 176 (5) :3070-3079.
|
[21] SZABO G, PETRASEK J. Inflammasome activation and func-tion in liver disease[J]. Nat Rev Gastroenterol Hepatol, 2015, 12 (7) :387-400.
|
[22] PANDEY S, KAWAI T, AKIRA S. Microbial sensing by Toll-like receptors and intracellular nucleic acid sensors[J]. ColdSpring Harb Perspect Biol, 2014, 7 (1) :a016246.
|
[23] GAVIN E, DAVID W. Pathogenesis of alcoholic liver disease[M]. USA:Springer, 2016:41-69.
|
[24] KONO H, ROCK KL. How dying cells alert the immune systemto danger[J]. Nat Rev Immunol, 2008, 8 (4) :279-289.
|
[25] WEISKIRCHEN R, TACKE F. Cellular and molecular functionsof hepatic stellate cells in inflammatory responses and liver im-munology[J]. Hepatobiliary Surg Nutr, 2014, 3 (6) :344-363.
|
[26] KIM HY, KIM CW, KIM TY, et al. Assessment of scoring sys-tems for acute-on-chronic liver failure at predicting short-term mortality in patients with alcoholic hepatitis[J]. World JGastroenterol, 2016, 22 (41) :9205-9213.
|
[27] GUSTOT T, FERNANDEZ J, GARCIA E, et al. Clinical courseof acute-on-chronic liver failure syndrome and effects onprognosis[J]. Hepatology, 2015, 62 (1) :243-252.
|
[28] CARR RM, CORRENTI J. Insulin resistance in clinical and ex-perimental alcoholic liver disease[J]. Ann N Y Acad Sci, 2015, 1353:1-20.
|
[29] KERWIN AJ, NUSSBAUM MS. Adjuvant nutrition managementof patients with liver failure, including transplant[J]. Surg ClinNorth Am, 2011, 91 (3) :565-578.
|
[30] HIGUERA-de la TIJERA F, SERVIN-CAAMANO A, SERVIN-ABAD L, et al. Malnutrition is a key prognostic factor relatedto high mortality-rate in patients with severe alcoholic hepati-tis[J]. Nutr Hosp, 2018, 35 (3) :677-682.
|
[31] MITCHELL MC, FRIEDMAN LS, MCCLAIN CJ. Medical man-agement of severe alcoholic hepatitis:Expert review from theclinical practice updates committee of the AGA institute[J].Clin Gastroenterol Hepatol, 2017, 15 (1) :5-12.
|
[32] THURSZ MR, RICHARDSON P, ALLISON M, et al. Predniso-lone or pentoxifylline for alcoholic hepatitis[J]. N Engl J Med, 2015, 372 (17) :1619-1628.
|
[33] LOUVET A, WARTEL F, CASTEL H, et al. Infection in patientswith severe alcoholic hepatitis treated with steroids:Early re-sponse to therapy is the key factor[J]. Gastroenterology, 2009, 137 (2) :541-548.
|
[34] MATHURIN P, O'GRADY J, CARITHERS RL, et al. Cortico-steroids improve short-term survival in patients with severe al-coholic hepatitis:Meta-analysis of individual patient data[J]. Gut, 2011, 60 (2) :255-260.
|
[35] GARCIA-SAENZ-DE-SICILIA M, DUVOOR C, ALTAMIRA-NO J, et al. A day-4 Lille model predicts response to cortico-steroids and mortality in severe alcoholic hepatitis[J]. Am JGastroenterol, 2017, 112 (2) :306-315.
|
[36] LEE BP, CHEN PH, HAUGEN C, et al. Three-year results ofa pilot program in early liver transplantation for severe alcoholichepatitis[J]. Ann Surg, 2017, 265 (1) :20-29.
|
[37] WEEKS SR, SUN Z, MCCAUL ME, et al. Liver transplantationfor severe alcoholic hepatitis, updated lessons from the world'slargest series[J]. J Am Coll Surg, 2018, 226 (4) :549-557.
|