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DOI: 10.1055/a-1671-9114
Pathophysiologie der Dekompensation bei Leberzirrhose – Prognose-Scores
Current pathophysiological concepts of acute decompensation in patients with liver cirrhosis and prognostic scores in different stages of disease![](https://www.thieme-connect.de/media/dmw/202211/lookinside/thumbnails/dmw-16719114_10-1055-a-1671-9114-1.jpg)
Was ist neu?
Die periphere arterielle Vasodilatations-Hypothese In der Vergangenheit war das führende Modell für die Erklärung der Entstehung von Dekompensationsereignissen bei der Zirrhose die periphere arterielle Vasodilatations-Hypothese. Diese hat man zuletzt zunehmend verlassen, stattdessen rückt eine chronische Inflammation in den Fokus.
Systemische Inflammation als Trigger für die Dekompensation der Leberzirrhose Aktuelle Studien konnten zeigen, dass bei der akuten Dekompensation (AD) wie dem ACLF ein inflammatorischer Status vorherrscht. Darüber hinaus ist die Inflammation auch eng mit dem weiteren klinischen Verlauf und der Prognose nach einem Dekompensationsereignis verknüpft.
Die Leberzirrhose als inflammatorisch getriggerte Multisystem-Erkrankung Der inflammatorische Zustand bei der Leberzirrhose führt über verschiedenste Mechanismen auch zu einer Beeinträchtigung der Funktion extrahepatischer Organsysteme, wie bspw. der Niere oder dem Herz. Die Leberzirrhose kann daher als inflammatorisch getriggerte Multisystem-Erkrankung betrachtet werden.
Neue klinische Scores bei Patienten mit einer Leberzirrhose Der zunehmende Fokus auf die Inflammation findet auch Berücksichtigung in aktuellen prognostischen Scores. So ist die Leukozytenzahl, als inflammatorischer Parameter, Bestandteil des CLIF-C-AD-Scores sowie des CLIF-C-ACLF-Scores, die der Prognoseabschätzung bei einer AD beziehungsweise einem ACLF dienen.
Abstract
Acute decompensation and acute-on chronic liver failure (ACLF) are associated with a significant reduced prognosis. Previously, the pathophysiological concept of acute decompensation was mainly based on the peripheral vasodilatation hypothesis. However, during the last years, systemic inflammation was recognized as a major driver for decompensation of liver cirrhosis and ACLF. Further, it has been shown that systemic inflammation is associated with the clinical course and the prognosis of the patients. Inflammation also affects the function of extrahepatic organs and therefore leads to the development of an inflammatory cirrhotic multi-organ syndrome. The importance of systemic inflammation in the context of decompensated liver cirrhosis is also transferred to new clinical scores such as the CLIF-C AD and CLIF-C ACLF score. In this article, we provide an overview of the new systemic inflammation hypothesis of decompensated cirrhosis and also discuss current clinical scores for prognostication in different stages of liver cirrhosis.
* geteilte Erstautorenschaft.
Publication History
Article published online:
30 May 2022
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