{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,7]],"date-time":"2026-06-07T07:29:57Z","timestamp":1780817397957,"version":"3.54.1"},"reference-count":29,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,9,18]],"date-time":"2023-09-18T00:00:00Z","timestamp":1694995200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004740","name":"Fondazione del Monte di Bologna e Ravenna","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004740","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003196","name":"Ministero della Salute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Aims<\/jats:title><jats:p>The PREDICT study recently showed that acutely decompensated (AD) patients with cirrhosis can present three different clinical phenotypes in the 90\u2009days after admission: (1) pre\u2010ACLF, developing acute\u2010on\u2010chronic liver failure (ACLF); (2) unstable decompensated cirrhosis (UDC), being re\u2010admitted for AD without ACLF and (3) stable decompensated cirrhosis (SDC), not presenting readmission or ACLF. This study aimed to externally validate the existence of these three distinct trajectories and to identify predictors for the occurrence of each trajectory.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Baseline data, 3\u2010month ACLF and readmission incidence and 1\u2010year survival were analysed in a prospective cohort of patients admitted for AD. A multinomial multivariable model was used to evaluate the association between baseline features and clinical trajectories.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 311 patients enrolled, 55% met the criteria for SDC, 18% for UDC and 27% for pre\u2010ACLF, presenting a significantly different 1\u2010year mortality: pre\u2010ACLF 65%, UDC 46%, SDC 21% (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). The presence of hepatic encephalopathy (HE) was associated with UDC (<jats:italic>p<\/jats:italic>\u2009=\u2009.043), while the absence of ascites to SDC (<jats:italic>p<\/jats:italic>\u2009=\u2009.017). Among laboratory parameters, an increase in MELD\u2010Na (<jats:italic>p<\/jats:italic>\u2009=\u2009.001) and C\u2010reactive protein (<jats:italic>p<\/jats:italic>\u2009=\u2009.009) and a decrease in haemoglobin (<jats:italic>p<\/jats:italic>\u2009=\u2009.004) and albumin (<jats:italic>p<\/jats:italic>\u2009=\u2009.008) levels were associated with pre\u2010ACLF.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The present study confirms that AD patients have three different clinical trajectories with different mortality rates. Besides the severity of cirrhosis, the association with C\u2010reactive protein supports the predominant role of systemic inflammation in ACLF pathophysiology. Finally, HE is associated with the UDC phenotype highlighting the need for better management of this complication after discharge.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.15734","type":"journal-article","created":{"date-parts":[[2023,9,18]],"date-time":"2023-09-18T07:43:15Z","timestamp":1695022995000},"page":"72-82","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Predictors of clinical trajectories of patients with acutely decompensated cirrhosis. An external validation of the <scp>PREDICT<\/scp> study"],"prefix":"10.1111","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2467-7027","authenticated-orcid":false,"given":"Enrico","family":"Pompili","sequence":"first","affiliation":[{"name":"Department of Medical and Surgical Sciences Alma Mater Studiorum\u2014University of Bologna  Bologna Italy"},{"name":"Unit of Semeiotics, Liver and Alcohol\u2010Related Diseases IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7865-394X","authenticated-orcid":false,"given":"Maurizio","family":"Baldassarre","sequence":"additional","affiliation":[{"name":"Unit of Semeiotics, Liver and Alcohol\u2010Related Diseases IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna  Bologna Italy"},{"name":"Centre for Applied Biomedical Research (CRBA) Alma Mater Studiorum of Bologna  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1495-9306","authenticated-orcid":false,"given":"Giorgio","family":"Bedogni","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences Alma Mater Studiorum\u2014University of Bologna  Bologna Italy"},{"name":"Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging \u201cS. Maria delle Croci\u201d Ravenna Hospital, AUSL Romagna  Ravenna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3219-6963","authenticated-orcid":false,"given":"Giacomo","family":"Zaccherini","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences Alma Mater Studiorum\u2014University of Bologna  Bologna Italy"},{"name":"Unit of Semeiotics, Liver and Alcohol\u2010Related Diseases IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3424-1289","authenticated-orcid":false,"given":"Giulia","family":"Iannone","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences Alma Mater Studiorum\u2014University of Bologna  Bologna Italy"},{"name":"Unit of Semeiotics, Liver and Alcohol\u2010Related Diseases IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"De\u00a0Venuto","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences Alma Mater Studiorum\u2014University of Bologna  Bologna Italy"},{"name":"Unit of Semeiotics, Liver and Alcohol\u2010Related Diseases IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dario","family":"Pratelli","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences Alma Mater Studiorum\u2014University of Bologna  Bologna Italy"},{"name":"Unit of Semeiotics, Liver and Alcohol\u2010Related Diseases IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0444-603X","authenticated-orcid":false,"given":"Francesco","family":"Palmese","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences Alma Mater Studiorum\u2014University of Bologna  Bologna Italy"},{"name":"Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging \u201cS. 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