{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:34:45Z","timestamp":1791520485638,"version":"4.3.4"},"reference-count":34,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T00:00:00Z","timestamp":1758585600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006012","name":"Christian Doppler Forschungsgesellschaft","doi-asserted-by":"publisher","award":["CD10271603"],"award-info":[{"award-number":["CD10271603"]}],"id":[{"id":"10.13039\/501100006012","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100016168","name":"Ludwig Boltzmann Gesellschaft","doi-asserted-by":"publisher","award":["LBG_KFG_22_32"],"award-info":[{"award-number":["LBG_KFG_22_32"]}],"id":[{"id":"10.13039\/501100016168","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>The impact of portal hypertension (PH) during acute\u2010on\u2010chronic liver failure (ACLF) remains unclear. This study investigated the link between underlying PH severity, systemic inflammation (SI), and the course of ACLF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Consecutive patients with ACLF (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009192) who met the EASL\u2010CLIF criteria were retrospectively included. PH severity (hepatic venous pressure gradient, HVPG; platelet count, PLT; and other clinical\/radiologic PH surrogates) and SI (white blood cell count; C\u2010reactive protein [CRP], interleukin\u20106) were assessed at the last pre\u2010ACLF visit, ACLF diagnosis (D0), and after 7 (D7), 28 (D28), and 90 (D90)\u2009days.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      All patients had clinical\/radiological signs of PH, and 91 (47%) patients developed ACLF grade 1, 62 (32%) ACLF\u20102, and 39 (21%) ACLF\u20103. Patients with different D0\u2010ACLF grades showed similar SI biomarker levels pre\u2010ACLF, whereas these increased significantly during ACLF. Median PLT decreased in parallel with the ACLF grade and from D0 (ACLF\u20103:72; vs. ACLF\u20102:81; vs. ACLF\u20101:91\u2009G\/L;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.094) to D7 (ACLF\u20103:39 vs. ACLF\u20102:64; vs. ACLF\u20101:89\u2009G\/L;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). In multivariable Cox regression models, D0\u2010PLT (aHR: 0.96 per 10\u2009G\/L [95% CI: 0.93\u20130.99],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.015) independently predicted D28 mortality. A logistic regression model including sex, D0\u2010PLT, D0\u2010CRP, and CLIF\u2010C ACLF score predicted D28 mortality (AUROC: 0.79 [0.73\u20130.86];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and outperformed (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.036) the MELD\u2010Na score (AUROC: 0.71 [0.63\u20130.78];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Although PH is a necessary condition for ACLF development, underlying PH severity does not confer a risk for higher ACLF severity but impacts survival after ACLF resolution. PLT emerged as a predictor of D28 mortality, independent of the CLIF\u2010C ACLF score.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/liv.70363","type":"journal-article","created":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T13:03:44Z","timestamp":1758632624000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Impact of Underlying Portal Hypertension on Severity and Course of Acute\u2010On\u2010Chronic Liver Failure"],"prefix":"10.1111","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2313-7881","authenticated-orcid":false,"given":"Vlad","family":"Taru","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine III Medical University of Vienna  Vienna Austria"},{"name":"Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III Medical University of Vienna  Vienna Austria"},{"name":"Iuliu Hatieganu University of Medicine and Pharmacy, 4th Dept. of Internal Medicine and \u201cOctavian Fodor\u201d Regional Institute of Gastroenterology and Hepatology, Hepatology Department  Cluj\u2010Napoca Romania"},{"name":"Christian\u2010Doppler Laboratory for Portal Hypertension and Liver Fibrosis Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1736-3699","authenticated-orcid":false,"given":"Georg","family":"Kramer","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine III Medical University of Vienna  Vienna Austria"},{"name":"Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III Medical University of Vienna  Vienna Austria"},{"name":"Clinical Research Group MOTION Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3403-3372","authenticated-orcid":false,"given":"Benedikt S.","family":"Hofer","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine III Medical University of Vienna  Vienna Austria"},{"name":"Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III Medical University of Vienna  Vienna Austria"},{"name":"Christian\u2010Doppler Laboratory for Portal Hypertension and Liver Fibrosis Medical University of Vienna  Vienna Austria"},{"name":"Clinical Research Group MOTION Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4615-915X","authenticated-orcid":false,"given":"Nina","family":"Dominik","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine III Medical University of Vienna  Vienna Austria"},{"name":"Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III Medical University of Vienna  Vienna Austria"},{"name":"Clinical Research Group MOTION Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6708-3061","authenticated-orcid":false,"given":"Lorenz","family":"Balcar","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine III Medical University of Vienna  Vienna Austria"},{"name":"Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III Medical University of Vienna  Vienna Austria"},{"name":"Clinical Research Group MOTION Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathias","family":"Schneeweiss\u2010Gleixner","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine III Medical University of Vienna  Vienna Austria"},{"name":"Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8118-1760","authenticated-orcid":false,"given":"Bogdan","family":"Procopet","sequence":"additional","affiliation":[{"name":"Iuliu Hatieganu University of Medicine and Pharmacy, 4th Dept. of Internal Medicine and \u201cOctavian Fodor\u201d Regional Institute of Gastroenterology and Hepatology, Hepatology Department  Cluj\u2010Napoca Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Trauner","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine III Medical University of Vienna  Vienna Austria"},{"name":"Clinical Research Group MOTION Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2330-0017","authenticated-orcid":false,"given":"Mattias","family":"Mandorfer","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine III Medical University of Vienna  Vienna Austria"},{"name":"Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III Medical University of Vienna  Vienna Austria"},{"name":"Clinical Research Group MOTION Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Schwabl","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine III Medical University of Vienna  Vienna Austria"},{"name":"Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III Medical University of Vienna  Vienna Austria"},{"name":"Christian\u2010Doppler Laboratory for Portal Hypertension and Liver Fibrosis Medical University of Vienna  Vienna Austria"},{"name":"Clinical Research Group MOTION Medical University of Vienna  Vienna Austria"},{"name":"CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4590-3583","authenticated-orcid":false,"given":"Thomas","family":"Reiberger","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine III Medical University of Vienna  Vienna Austria"},{"name":"Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III Medical University of Vienna  Vienna Austria"},{"name":"Christian\u2010Doppler Laboratory for Portal Hypertension and Liver Fibrosis Medical University of Vienna  Vienna Austria"},{"name":"Clinical Research Group MOTION Medical University of Vienna  Vienna Austria"},{"name":"CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8181-9146","authenticated-orcid":false,"given":"Benedikt","family":"Simbrunner","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine III Medical University of Vienna  Vienna Austria"},{"name":"Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III Medical University of Vienna  Vienna Austria"},{"name":"Christian\u2010Doppler Laboratory for Portal Hypertension and Liver Fibrosis Medical University of Vienna  Vienna Austria"},{"name":"Clinical Research Group MOTION Medical University of Vienna  Vienna Austria"},{"name":"CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,23]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.06.018"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2013.02.042"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.11.019"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.12.022"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.28824"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072\u2010023\u201010496\u2010y"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2012.12.011"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl\u20102020\u2010322712"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2020.03.065"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.01.002"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.12783"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl\u20102012\u2010304038"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00508\u2010012\u20100190\u20105"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00508\u2010013\u20100337\u2010z"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00508\u2010017\u20101262\u20103"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00508\u2010023\u201002229\u2010w"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0186674"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/0197\u20102456(96)00075\u2010X"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.JHEP.2020.11.048"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/ueg2.12089"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1053\/gast.2001.25536"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.20386"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102036.2007.03258.x"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620\u2010023\u201008144\u20104"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.1378\/CHEST.10\u20102243"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01709751"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.25421"},{"key":"e_1_2_13_29_1","doi-asserted-by":"publisher","DOI":"10.3109\/09537104.2012.696748"},{"key":"e_1_2_13_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.07.020"},{"key":"e_1_2_13_31_1","doi-asserted-by":"publisher","DOI":"10.1038\/AJG.2017.457"},{"key":"e_1_2_13_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.13317"},{"key":"e_1_2_13_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2024.03.007"},{"key":"e_1_2_13_34_1","doi-asserted-by":"publisher","DOI":"10.1097\/HEP.0000000000000740"},{"key":"e_1_2_13_35_1","doi-asserted-by":"publisher","DOI":"10.3389\/FIMMU.2022.1037645"}],"container-title":["Liver International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/liv.70363","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T16:42:18Z","timestamp":1765989738000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/liv.70363"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,23]]},"references-count":34,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1111\/liv.70363"],"URL":"https:\/\/doi.org\/10.1111\/liv.70363","archive":["Portico"],"relation":{},"ISSN":["1478-3223","1478-3231"],"issn-type":[{"value":"1478-3223","type":"print"},{"value":"1478-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,23]]},"assertion":[{"value":"2025-02-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-23","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70363"}}