DECISION strives to better understand the pathophysiology of decompensated cirrhosis leading to acute-on-chronic liver failure (ACLF) at the systems level by taking advantage of already existing large and clinically well-characterized patient cohorts. The ultimate goal is to significantly reduce mortality through combinatorial therapies that are tailored to the specific needs of individual patients. Part of this endeavour is to develop (1) a reliable prognostic test to identify patients that are at risk for a poor outcome following standard therapy but who may benefit from a novel and personalised combinatorial therapy, and (2) a robust response test to predict the success of a novel combinatorial therapy as opposed to more aggressive solutions like a liver transplant.
Currently, amongst those patients that present with acute decompensation of cirrhosis in the clinic, 5% still die within the first month, 14% within three months, despite extensive efforts of standard medical treatment to preserve their live. We envision a future with much higher survival rates where a mechanism-based prognostic test robustly predicts which patients may have a poor outcome following standard treatment and would instead either benefit from a novel combinatorial therapy that is tailored to their specific needs or from a more aggressive strategy like a liver transplant.