1. Acute variceal bleeding portends poor outcomes in patients with acute-on-chronic liver failure: a propensity score matched study from the APASL ACLF Research Consortium (AARC)
- Author
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Sanchit, Sharma, Samagra, Agarwal, Anoop, Saraya, Ashok, Choudhury, Mamun Al, Mahtab, Mohd Shahinul, Alam, Sanjiv, Saigal, Dong Joon, Kim, C E, Eapen, Ashish, Goel, Qin, Ning, Harshad, Devarbhavi, Virendra, Singh, Akash, Shukla, Saeed, Hamid, Jinhua, Hu, Soek-Siam, Tan, Anil, Arora, Manoj Kumar, Sahu, Mohd, Rela, Dinesh, Jothimani, P N, Rao, Anand, Kulkarni, Hashmik, Ghaznian, Guan Huei, Lee, Duan, Zhongping, Ajit, Sood, Omesh, Goyal, Laurentius A, Lesmana, Rinaldi C, Lesmana, Sombat, Treeprasertsuk, Nan, Yuemin, Samir, Shah, Han, Tao, V M, Dayal, Xin, Shaojie, Fazal, Karim, Zaigham, Abbas, Jose D, Sollano, Kemal Fariz, Kalista, Ananta, Shreshtha, Diana, Payawal, Masao, Omata, Shiv Kumar, Sarin, and Jin Mo, Yang
- Subjects
Male ,Hepatitis, Alcoholic ,Acute-On-Chronic Liver Failure ,Humans ,Female ,Esophageal and Gastric Varices ,Gastrointestinal Hemorrhage ,Prognosis ,Propensity Score - Abstract
Limited data exist regarding outcomes of acute variceal bleeding (AVB) in patients with acute-on-chronic liver failure (ACLF), especially in those with hepatic failure. We evaluated the outcomes of AVB in patients with ACLF in a multinational cohort of APASL ACLF Research Consortium (AARC).Prospectively maintained data from AARC database on patients with ACLF who developed AVB (ACLF-AVB) was analysed. This data included demographic profile, severity of liver disease, and rebleeding and mortality in 6 weeks. These outcomes were compared with a propensity score matched (PSM) cohort of ACLF matched for severity of liver disease (MELD, AARC score) without AVB (ACLF without AVB).Of the 4434 ACLF patients, the outcomes in ACLF-AVB (n = 72) [mean age-46 ± 10.4 years, 93% males, 66% with alcoholic liver disease, 65% with alcoholic hepatitis, AARC score: 10.1 ± 2.2, MELD score: 34 (IQR: 27-40)] were compared with a PSM cohort selected in a ratio of 1:2 (n = 143) [mean age-44.9 ± 12.5 years, 82.5% males, 48% alcoholic liver disease, 55.7% alcoholic hepatitis, AARC score: 9.4 ± 1.5, MELD score: 32 (IQR: 24-40)] of ACLF-without AVB. Despite PSM, ACLF patients with AVB had a higher baseline HVPG than without AVB (25.00 [IQR: 23.00-28.00] vs. 17.00 [15.00-21.75] mmHg; p = 0.045). The 6-week mortality in ACLF patients with or without AVB was 70.8% and 53.8%, respectively (p = 0.025). The 6-week rebleeding rate was 23% in ACLF-AVB. Presence of ascites [hazard ratio (HR) 2.2 (95% CI 1.03-9.8), p = 0.026], AVB [HR 1.9 (95% CI 1.2-2.5, p = 0.03)], and MELD score [HR 1.7 (95% CI 1.1-2.1), p = 0.001] independently predicted mortality in the overall ACLF cohort.Development of AVB confers poor outcomes in patients with ACLF with a high 6-week mortality. Elevated HVPG at baseline represents a potential risk factor for future AVB in ACLF.
- Published
- 2022