TORNA ALL’ELENCO

Sex disparities in acute-on-chronic liver failure: From admission to the intensive care unit to liver transplantation in Digestive and Liver Disease

2024
ASL Cuneo 1

Tipo pubblicazione

Article in Press

Autori/Collaboratori (15)Vedi tutti...

Cerutti E
Department of Anesthesia, Transplant and Surgical Intensive Care, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
D'Arcangelo F
Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
Becchetti C
Hepatology and Gastroenterology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

et alii...

Abstract

Acute-on-chronic liver failure (ACLF) is a severe clinical syndrome characterized by acute liver decompensation in patients with chronic liver disease, marked by systemic inflammation and systemic organ failure. In this review, we discussed sex-related disparities in the incidence, prognosis, and access to liver transplantation (LT) for patients with ACLF, particularly during Intensive Care Unit (ICU) management. Some studies have suggested that ACLF is more prevalent among male patients admitted to the ICU, and they have higher mortality rates than females. Available prognostic scores, such as CLIF-C or TAM-score, lack sex-specific adjustments. Sarcopenia seems to enhance the accuracy of these scores though this is observed only in male individuals. LT is the only effective treatment for patients with ACLF grade 2–3 who do not respond to medical therapies. Sex-related disparities occur in both access to LT and post-transplant outcomes, although the influence of sex on the prevalence, clinical course, and listing for LT in ACLF remains largely undetermined. A sex-orientated analysis of ICU outcomes in ACLF would facilitate the development of sex-orientated management strategies, thereby improving patients’ outcomes.

PMID : 39164168

DOI : 10.1016/j.dld.2024.08.002

Keywords

biological marker; acute on chronic liver failure; adult; chronic liver disease; controlled study; decompensated liver cirrhosis; disease course; drug therapy; female; gender; human; incidence; inflammation; intensive care; intensive care unit; liver cirrhosis; liver transplantation; male; middle aged; mortality rate; prevalence; prognosis; review; sarcopenia; sex;