{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T04:31:53Z","timestamp":1785472313974,"version":"3.56.0"},"reference-count":43,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,9,9]],"date-time":"2023-09-09T00:00:00Z","timestamp":1694217600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100009104","name":"Department of Health Research, India","doi-asserted-by":"publisher","award":["GIA\/2019\/00281\/PRCGIA"],"award-info":[{"award-number":["GIA\/2019\/00281\/PRCGIA"]}],"id":[{"id":"10.13039\/501100009104","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Point\u2010of\u2010care echocardiography (POC\u2010Echo) is an essential intensive care hemodynamic monitoring tool.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To assess POC\u2010Echo parameters [<jats:italic>i.e<\/jats:italic>., cardiac index (CI), systemic vascular resistance index (SVRI) and cirrhotic cardiomyopathy (CCM) markers] and serum biomarkers in predicting circulatory failure (need for vasopressors) and mortality in patients with acute\u2010on\u2010chronic liver failure (ACLF) having sepsis\u2010induced hypotension.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed serial POC\u2010Echo within 6\u2009hours (h)\u00a0of presentation and subsequently at 24, 48 and 72\u2009h in patients with ACLF and sepsis\u2010induced hypotension admitted to our liver intensive care unit. Clinical data, POC\u2010Echo data and serum biomarkers were collected prospectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We enrolled 120 patients [59% men, aged 49\u2009\u00b1\u200912\u2009years, 56% alcohol\u2010related disease and median MELDNa of 30 (27\u201332)], of whom 68 (56.6%) had circulatory failure, with overall mortality of 60%. CCM was present in 52.5%. The predictors of circulatory failure were CI (aHR \u22121.5; <jats:italic>p<\/jats:italic>\u2009=\u20090.021), N\u2010terminal brain natriuretic peptide (aHR \u22121.1; <jats:italic>p<\/jats:italic>\u2009=\u20090.007) and CCM markers; e\u2032 septal mitral velocity (aHR \u22120.5; <jats:italic>p<\/jats:italic>\u2009=\u20090.039) and E\/e\u2032 ratio (aHR \u22121.2; <jats:italic>p<\/jats:italic>\u2009=\u20090.045). Reduction in CI by 20% and SVRI by 15% at 72\u2009h predicted mortality with a sensitivity of 84% and 72%, and specificity 76% and 65%, respectively (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). The MELD\u2010CCM model and CLIF\u2010CCM model were computed as MELDNa\u2009+\u20091.815\u2009\u00d7\u2009E\/e\u2032 (septal)\u2009+\u20090.402\u2009\u00d7\u2009e\u2032 (septal) and CLIF\u2010C ACLF\u2009+\u20091.815\u2009\u00d7\u2009E\/e\u2032 (septal)\u2009+\u20090.402\u2009\u00d7\u2009e\u2032 (septal), respectively, based on multivariable logistic regression. Both scores outperformed MELDNa (z\u2010score\u2009=\u2009\u22122.073, <jats:italic>p<\/jats:italic>\u2009=\u20090.038) and CLIF\u2010C ACLF score (z score\u2009=\u2009\u22122.683, <jats:italic>p<\/jats:italic>\u2010value\u2009=\u20090.007), respectively, in predicting 90\u2010day mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>POC\u2010Echo measurements such as CCM markers (E\/e' and e' velocity) and change in CI reliably predict circulatory failure and mortality in ACLF with severe sepsis. CCM markers significantly enhanced the CLIF\u2010C ACLF and MELDNa predictive performance.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.17695","type":"journal-article","created":{"date-parts":[[2023,9,9]],"date-time":"2023-09-09T07:10:45Z","timestamp":1694243445000},"page":"903-919","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Cirrhotic cardiomyopathy influences clinical outcomes and enhances performance of conventional risk prediction models in acute\u2010on\u2010chronic liver failure with severe sepsis"],"prefix":"10.1111","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3271-0122","authenticated-orcid":false,"given":"Kamal","family":"Kajal","sequence":"first","affiliation":[{"name":"Departments of Anesthesia and Intensive Care Postgraduate Institute of Medical Education and Research  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2961-4148","authenticated-orcid":false,"given":"Madhumita","family":"Premkumar","sequence":"additional","affiliation":[{"name":"Departments of Hepatology Postgraduate Institute of Medical Education and Research  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manhal","family":"Izzy","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology, and Nutrition Vanderbilt University  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1240-1675","authenticated-orcid":false,"given":"Anand V.","family":"Kulkarni","sequence":"additional","affiliation":[{"name":"Department of Hepatology Asian Institute of Gastroenterology  Hyderabad India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3590-2664","authenticated-orcid":false,"given":"Ajay Kumar","family":"Duseja","sequence":"additional","affiliation":[{"name":"Departments of Hepatology Postgraduate Institute of Medical Education and Research  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Smita","family":"Divyaveer","sequence":"additional","affiliation":[{"name":"Departments of Nephrology Postgraduate Institute of Medical Education and Research  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sekar","family":"Loganathan","sequence":"additional","affiliation":[{"name":"Departments of Anesthesia and Intensive Care Postgraduate Institute of Medical Education and Research  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhupendra","family":"Sihag","sequence":"additional","affiliation":[{"name":"Departments of Cardiology Postgraduate Institute of Medical Education and Research  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ankur","family":"Gupta","sequence":"additional","affiliation":[{"name":"Departments of Cardiology Postgraduate Institute of Medical Education and Research  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajay","family":"Bahl","sequence":"additional","affiliation":[{"name":"Departments of Cardiology Postgraduate Institute of Medical Education and Research  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6529-9080","authenticated-orcid":false,"given":"Sahaj","family":"Rathi","sequence":"additional","affiliation":[{"name":"Departments of Hepatology Postgraduate Institute of Medical Education and Research  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3901-6969","authenticated-orcid":false,"given":"Sunil","family":"Taneja","sequence":"additional","affiliation":[{"name":"Departments of Hepatology Postgraduate Institute of Medical Education and Research  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8567-1676","authenticated-orcid":false,"given":"Arka","family":"De","sequence":"additional","affiliation":[{"name":"Departments of Hepatology Postgraduate Institute of Medical Education and Research  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4328-0914","authenticated-orcid":false,"given":"Nipun","family":"Verma","sequence":"additional","affiliation":[{"name":"Departments of Hepatology Postgraduate Institute of Medical Education and Research  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Navneet","family":"Sharma","sequence":"additional","affiliation":[{"name":"Departments of Internal Medicine Postgraduate Institute of Medical Education and Research  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harpreet","family":"Kaur","sequence":"additional","affiliation":[{"name":"Departments of Hepatology Postgraduate Institute of Medical Education and Research  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5054-4001","authenticated-orcid":false,"given":"Deepy","family":"Zohmangaihi","sequence":"additional","affiliation":[{"name":"Departments of Biochemistry Postgraduate Institute of Medical Education and Research  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vishesh","family":"Kumar","sequence":"additional","affiliation":[{"name":"Departments of Hepatology Postgraduate Institute of Medical Education and Research  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harish","family":"Bhujade","sequence":"additional","affiliation":[{"name":"Departments of Radiodiagnosis and Interventional Radiology Postgraduate Institute of Medical Education and Research  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sreedhara B.","family":"Chaluvashetty","sequence":"additional","affiliation":[{"name":"Departments of Radiodiagnosis and Interventional Radiology Postgraduate Institute of Medical Education and Research  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naveen","family":"Kalra","sequence":"additional","affiliation":[{"name":"Departments of Radiodiagnosis and Interventional Radiology Postgraduate Institute of Medical Education and Research  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,9,9]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620\u2010008\u20100421\u20109"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134\u2010019\u201005596\u2010z"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-004-2259-8"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/0885066620988281"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jceh.2021.08.016"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134\u2010016\u20104500\u20107"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2017.12.027"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.26000"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.30875"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41581\u2010018\u20100044\u20100"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2022.03.043"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2015.10.019"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1703058"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2014.06.012"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2013.02.042"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.0287"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.101.6.1644"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.0289"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2016.01.011"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.15559"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/jgh3.12166"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jceh.2017.11.008"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010022\u201009505\u20101"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jceh.2022.11.014"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10741\u2010016\u20109552\u20109"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100038\u20101672139"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134\u2010005\u20102619\u2010z"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc7712"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40560\u2010016\u20100148\u20101"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000003960"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartasia\u20102011\u2010010023"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2014.08.041"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41569\u2010020\u20100433\u20105"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.30916"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2020201057"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.26460"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCC.0000000000000067"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12876\u2010022\u201002351\u20105"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1177\/08850666211049749"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12882\u2010016\u20100323\u20106"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.07.046"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.31884"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ccm.0000178182.37639.d6"}],"container-title":["Alimentary Pharmacology &amp; Therapeutics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apt.17695","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,13]],"date-time":"2023-10-13T15:57:05Z","timestamp":1697212625000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/apt.17695"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,9]]},"references-count":43,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2023,11]]}},"alternative-id":["10.1111\/apt.17695"],"URL":"https:\/\/doi.org\/10.1111\/apt.17695","archive":["Portico"],"relation":{},"ISSN":["0269-2813","1365-2036"],"issn-type":[{"value":"0269-2813","type":"print"},{"value":"1365-2036","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,9]]},"assertion":[{"value":"2023-05-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-08-17","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-09-09","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}