{
  "abstract": "Background and aims: Definitions of acute-on-chronic liver failure (ACLF) differ, with a focus on extrahepatic organ failures on the basis of previously compensated or decompensated cirrhosis in EASL-CLIF-ACLF versus hepatic failure in patients without previous decompensation in APASL-ACLF. Here, we explored whether patterns of systemic inflammation and immune cell alterations differ between these types of ACLF.\n\nMethods: Consecutive patients with acute decompensation, EASL-CLIF- or APASL-ACLF were recruited from two liver centres. Patterns of systemic inflammation were characterized by Olink analysis and changes in circulating immune cells by flow cytometry.\n\nResults: A total of 374 patients with acute decompensation (AD) were identified, of whom 56 fulfilled exclusively the EASL-CLIF-definition of ACLF (15% of all patients), while only 19 patients (5.1% of all patients) met exclusively the APASL-definition. APASL-ACLF was associated with higher bilirubin, lower creatinine, higher INR and higher hemoglobin concentrations compared to EASL-ACLF. Patterns of systemic inflammation differed between EASL-CLIF and APASL-ACLF. For example, FGF-23, IL-17 or VEGF-A were associated with EASL-CLIF-ACLF, while FGF-19 or low IL-12 were associated with APASL-ACLF. Moreover, patients with EASL-CLIF-ACLF had significantly lower counts of CD8+ T cells, while in APASL-ACLF a reduction of CD4+ T cell was characteristic. Detailed immune cell phenotyping revealed distinct expression of co-stimulatory molecules, inhibitory molecules and T cell activation markers in APASL-ACLF compared to patients with AD or EASL-CLIF-ACLF.\n\nConclusion: We provide preliminary evidence that EASL-CLIF- and APASL-ACLF are associated with different changes in systemic inflammation patterns and immune cell phenotypes, suggesting that both types of ACLF might be pathophysiologically different.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Internal Medicine II, LMU University Hospital",
    "Department for Gastroenterology and Hepatology, University Hospital Essen, University Duisburg-Essen",
    "Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Mona-May Langer"
    },
    {
      "affs": [
        0
      ],
      "name": "Marc J. Weiss"
    },
    {
      "affs": [
        0
      ],
      "name": "Alina Bauschen"
    },
    {
      "affs": [
        1
      ],
      "name": "Sabrina Guckenbiehl"
    },
    {
      "affs": [
        0
      ],
      "name": "Gerald Denk"
    },
    {
      "affs": [
        0
      ],
      "name": "Helena Stadler"
    },
    {
      "affs": [
        0,
        2
      ],
      "name": "Christian M. Lange"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/1fca2qp7cfm5a.bib",
  "cited_by": 0,
  "doi": "10.3389/fimmu.2026.1893968",
  "fulltext_url": "https://europepmc.org/articles/PMC13680246",
  "id": "1fca2qp7cfm5a",
  "issns": [
    "1664-3224"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fimmu.2026.1893968/full",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2721|Liver Disease and Transplantation"
    ]
  ],
  "openalex": "W7220732784",
  "pdf_url": "https://europepmc.org/articles/PMC13680246?pdf=render",
  "pmcid": "PMC13680246",
  "pmid": "42903219",
  "published": "2026-10-06",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/1fca2qp7cfm5a.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:15Z",
      "native_id": "10.3389/fimmu.2026.1893968",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fimmu.2026.1893968/full"
    },
    {
      "first_seen": "2026-10-30T12:19:57Z",
      "native_id": "MED:42903219",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42903219"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "issn:1664-3224",
      "subfield": "immunology"
    }
  ],
  "title": "APASL-ACLF without previous decompensation is immunologically distinct from EASL-CLIF-ACLF with previous decompensation",
  "title_text": "APASL-ACLF without previous decompensation is immunologically distinct from EASL-CLIF-ACLF with previous decompensation",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:57Z",
  "url": "https://research.draconitic.com/paper/1fca2qp7cfm5a",
  "venue": "Frontiers in Immunology",
  "versions": []
}