Forskning
Udskriv Udskriv
Switch language
Region Hovedstaden - en del af Københavns Universitetshospital
Udgivet

Rebleeding and mortality risk are increased by ACLF but reduced by pre-emptive TIPS

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

DOI

  1. rs641738C>T near MBOAT7 is associated with liver fat, ALT and fibrosis in NAFLD: A meta-analysis

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  2. The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  3. Standardisation of diet and exercise in clinical trials of NAFLD-NASH: Recommendations from the Liver Forum

    Publikation: Bidrag til tidsskriftReviewForskningpeer review

  4. Natural History of Histologically-proven Alcohol Related Liver Disease: A systematic review

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  1. Glucagon acutely regulates hepatic amino acid catabolism and the effect may be disturbed by steatosis

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  2. Nonalcoholic Fatty Liver Disease Impairs the Liver-Alpha Cell Axis Independent of Hepatic Inflammation and Fibrosis

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  3. Tunneled Peritoneal Catheter for Refractory Ascites in Cirrhosis: A Randomized Case-Series

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  • International Variceal Bleeding Observational Study Group and Baveno Cooperation
Vis graf over relationer

BACKGROUND & AIMS: The relationship between acute-on-chronic liver failure (ACLF) and acute variceal bleeding (AVB) is poorly understood. Specifically, the prevalence and prognosis of ACLF in the context of AVB is unclear, while the role of transjugular intrahepatic portosystemic shunt (TIPS) in the management in patients with ACLF has not been described to date.

METHODS: A multicenter, international, observational study was conducted in 2,138 patients from 34 centers between 2011 and 2015. ACLF was defined and graded according to the EASL-CLIF consortium definition. Placement of pre-emptive TIPS (pTIPS) was based on individual center policy. Patients were followed-up for 1 year, until death or liver transplantation. Cox regression and competing risk models (Gray's test) were used to identify independent predictors of rebleeding or mortality.

RESULTS: At admission, 380/2,138 (17.8%) patients had ACLF according to EASL-CLIF criteria (grade 1: 38.7%; grade 2: 39.2%; grade 3: 22.1%). The 42-day rebleeding (19% vs. 10%; p <0.001) and mortality (47% vs. 10%; p <0.001) rates were higher in patients with ACLF and increased with ACLF grades. Of note, the presence of ACLF was independently associated with rebleeding and mortality. pTIPS placement improved survival in patients with ACLF at 42 days and 1 year. This effect was also observed in propensity score matching analysis of 66 patients with ACLF, of whom 44 received pTIPs and 22 did not.

CONCLUSIONS: This large multicenter international real-life study identified ACLF at admission as an independent predictor of rebleeding and mortality in patients with AVB. Moreover, pTIPS was associated with improved survival in patients with ACLF and AVB.

LAY SUMMARY: Acute variceal bleeding is a deadly complication of liver cirrhosis that results from severe portal hypertension. This study demonstrates that the presence of acute-on-chronic liver failure (ACLF) is the strongest predictor of mortality in patients with acute variceal bleeding. Importantly, patients with ACLF and acute variceal (re)bleeding benefit from pre-emptive (early) placement of a transjugular intrahepatic portosystemic shunt.

OriginalsprogEngelsk
TidsskriftJournal of Hepatology
Vol/bind73
Udgave nummer5
Sider (fra-til)1082-1091
Antal sider10
ISSN0168-8278
DOI
StatusUdgivet - 1 nov. 2020

Bibliografisk note

Copyright © 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

ID: 59756119