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

Elisabetta Cerutti; Francesca D'Arcangelo; Chiara Becchetti; Marta Cilla; Valentina Cossiga; Maria Guarino; Federica Invernizzi; Lucia Lapenna; Bruna Lavezzo; Fabio Marra; Manuela Merli; Maria Cristina Morelli; Pierluigi Toniutto; Patrizia Burra; Alberto Zanetto; Special Interest Group “Gender in Hepatology” of the Italian Association for the Study of the Liver (AISF)

doi:10.1016/j.dld.2024.08.002

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

Dig Liver Dis. 2024 Aug 19:S1590-8658(24)00921-6. doi: 10.1016/j.dld.2024.08.002. Online ahead of print.

Authors

Elisabetta Cerutti¹, Francesca D'Arcangelo², Chiara Becchetti³, Marta Cilla⁴, Valentina Cossiga⁵, Maria Guarino⁵, Federica Invernizzi⁴, Lucia Lapenna⁶, Bruna Lavezzo⁷, Fabio Marra⁸, Manuela Merli⁶, Maria Cristina Morelli⁹, Pierluigi Toniutto¹⁰, Patrizia Burra¹¹, Alberto Zanetto²; Special Interest Group “Gender in Hepatology” of the Italian Association for the Study of the Liver (AISF)

Affiliations

¹ Department of Anesthesia, Transplant and Surgical Intensive Care, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy.
² Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy; Gastroenterology and Multivisceral Transplant Unit, Padua University Hospital, Padua, Italy.
³ Hepatology and Gastroenterology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
⁴ Center for Liver Disease, Division of Internal Medicine and Hepatology, IRCCS Ospedale San Raffaele, 20132 Milan, Italy.
⁵ Diseases of the Liver and Biliary System Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy.
⁶ Department of Translational and Precision Medicine, Sapienza University of Rome, Italy.
⁷ Emergency Department, Anesthesia and Intensive Care Unit, SS Annunziata Hospital, Savigliano ASL Cuneo, Italy.
⁸ Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
⁹ Internal Medicine Unit for the Treatment of Severe Organ Failure, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy.
¹⁰ Hepatology and Liver Transplantation Unit, Academic Hospital, University of Udine, Udine, Italy.
¹¹ Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy; Gastroenterology and Multivisceral Transplant Unit, Padua University Hospital, Padua, Italy. Electronic address: burra@unipd.it.

PMID: 39164168
DOI: 10.1016/j.dld.2024.08.002

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.

Keywords: ACLF; Gender; ICU; Liver transplantation; Sex.

Publication types

Review