Acute decompensation (AD) of cirrhosis marks a critical turning point in advanced liver disease and is associated with high short-term mortality. Identifying which patients are at greatest risk within the first 90 days remains a major clinical challenge, as existing scoring systems do not fully capture the biological complexity underlying rapid deterioration.
In our latest video, we present findings from the DECISION project investigating Large Extracellular Vesicles (lEVs), circulating particles released by stressed or damaged cells that carry molecular information about ongoing disease processes.

By analyzing the protein cargo of lEVs in patients with acute decompensation, we identified a distinct three-protein signature derived from the liver, immune system, and kidney that was strongly associated with mortality. Importantly, integrating these molecular markers into the established CLIF-C AD score significantly improved its predictive performance for 90-day mortality.

These results highlight the potential of combining clinical scoring systems with molecular biomarkers to refine risk stratification and support earlier, more targeted clinical decision-making in advanced liver disease.
📖 Keep an eye out for the publication!
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In this video, we explore how emergency granulopoiesis, the rapid production of immune cells during crisis, becomes defective in acute liver failure. Using the analogy of a fire station releasing firefighters, Ferran Aguilar, biostatistician and first author of the accompanying paper, illustrates how the body’s emergency response can spiral into a vicious cycle: liver injury triggers immune chaos, which in turn fuels further damage.

Our findings reveal that this is not simply an exaggerated immune response. Instead, the immune “factory” begins producing the wrong cells at the wrong time, contributing to disease progression.

Understanding this defective emergency program opens the door to new therapeutic strategies, not to suppress the immune system, but to help it generate the right response when it is needed most.

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📖 Read the publication Maladaptive emergency granulopoiesis predicts poor outcomes in patients hospitalized with decompensated cirrhosis.