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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).
Sharma, Sanchit; Agarwal, Samagra; Saraya, Anoop; Choudhury, Ashok; Mahtab, Mamun Al; Alam, Mohd Shahinul; Saigal, Sanjiv; Kim, Dong Joon; Eapen, C E; Goel, Ashish; Ning, Qin; Devarbhavi, Harshad; Singh, Virendra; Shukla, Akash; Hamid, Saeed; Hu, Jinhua; Tan, Soek-Siam; Arora, Anil; Sahu, Manoj Kumar; Rela, Mohd; Jothimani, Dinesh; Rao, P N; Kulkarni, Anand; Ghaznian, Hashmik; Lee, Guan Huei; Zhongping, Duan; Sood, Ajit; Goyal, Omesh; Lesmana, Laurentius A; Lesmana, Rinaldi C; Treeprasertsuk, Sombat; Yuemin, Nan; Shah, Samir; Tao, Han; Dayal, V M; Shaojie, Xin; Karim, Fazal; Abbas, Zaigham; Sollano, Jose D; Kalista, Kemal Fariz; Shreshtha, Ananta; Payawal, Diana; Omata, Masao; Sarin, Shiv Kumar.
Affiliation
  • Sharma S; Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110029, India.
  • Agarwal S; Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110029, India.
  • Saraya A; Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110029, India. ansaraya@yahoo.com.
  • Choudhury A; Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
  • Mahtab MA; Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
  • Alam MS; Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
  • Saigal S; Department of Hepatology, Medanta The Medicity, Gurgaon, India.
  • Kim DJ; Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea.
  • Eapen CE; Department of Hepatology, Christan Medical College, Vellore, India.
  • Goel A; Department of Hepatology, Christan Medical College, Vellore, India.
  • Ning Q; Department of Medicine, Tongji Hospital, Tongji Medical College, Wuhan, China.
  • Devarbhavi H; Department of Hepatology, St Johns Medical College, Bangalore, India.
  • Singh V; 9Department of Hepatology, PGIMER, Chandigarh, India.
  • Shukla A; LTMMC, Mumbai, India.
  • Hamid S; Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
  • Hu J; Department of Medicine, Military Hospital, Beijing, 302, China.
  • Tan SS; Department of Medicine, Hospital Selayang, Bata Cabs, Selangor, Malaysia.
  • Arora A; Department of Gastroenterology, Sir Ganga Ram Hospital and GRIPMER, Delhi, India.
  • Sahu MK; Department of Hepatology, IMS and SUM Hospital, Bhubaneshwar, Odisha, India.
  • Rela M; Department of Liver Transplant Surgery, Dr. Rela Institute and Medical Centre, Chennai, India.
  • Jothimani D; Department of Liver Transplant Surgery, Dr. Rela Institute and Medical Centre, Chennai, India.
  • Rao PN; Asian Institute of Gastroenterology, Hyderabad, India.
  • Kulkarni A; Asian Institute of Gastroenterology, Hyderabad, India.
  • Ghaznian H; Department of Hepatology, Nork Clinical Hospital of Infectious Disease, Yerevan, Armenia.
  • Lee GH; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
  • Zhongping D; Translational Hepatology Institute Capital Medical University, Beijing You' an Hospital, Beijing, China.
  • Sood A; Department of Gastroenterology, Dayanand Medical College, Ludhiana, India.
  • Goyal O; Department of Gastroenterology, Dayanand Medical College, Ludhiana, India.
  • Lesmana LA; Department of Medicine, Medistra Hospital, Jakarta, Indonesia.
  • Lesmana RC; Department of Medicine, Medistra Hospital, Jakarta, Indonesia.
  • Treeprasertsuk S; Department of Medicine, Chulalongkorn University, Bangkok, Thailand.
  • Yuemin N; Hebei Medical University, Shijiazhuang, China.
  • Shah S; Department of Hepatology, Global Hospital, Mumbai, India.
  • Tao H; Tianjin Institute of Hepatobiliary Disease, Tianjin, China.
  • Dayal VM; IGIMS, Patna, India.
  • Shaojie X; Medical School of Chinese PLA, Beijing, China.
  • Karim F; Department of Hepatology, Sir Salimullah Medical College, Dhaka, Bangladesh.
  • Abbas Z; Department of Medicine, Ziauddin University Hospital, Karachi, Pakistan.
  • Sollano JD; Department of Medicine, University of Santo Tomas, Manila, Philippines.
  • Kalista KF; Division of Hepetobiliary, Cipto Mangunkusuamo Hospital, University of Indonesia, Jakarta, Indonesia.
  • Shreshtha A; Department of Hepatology, Foundation Nepal, Sitapaila Height, Kathmandu, Nepal.
  • Payawal D; Department of Medicine, Cardinal Santos Medical Center, Metro Manila, Philippines.
  • Omata M; Department of Hepatology, Yamanashi Central and Kita Hospitals, University of Tokyo, Tokyo, Japan.
  • Sarin SK; Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India. shivsarin@gmail.com.
Hepatol Int ; 16(5): 1234-1243, 2022 Oct.
Article in En | MEDLINE | ID: mdl-35851437
ABSTRACT
BACKGROUND AND

AIMS:

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).

METHODS:

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).

RESULTS:

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 12 (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.

CONCLUSION:

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.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Esophageal and Gastric Varices / Acute-On-Chronic Liver Failure / Hepatitis, Alcoholic Type of study: Prognostic_studies / Risk_factors_studies Limits: Female / Humans / Male Language: En Journal: Hepatol Int Year: 2022 Document type: Article
Fulltext
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Esophageal and Gastric Varices / Acute-On-Chronic Liver Failure / Hepatitis, Alcoholic Type of study: Prognostic_studies / Risk_factors_studies Limits: Female / Humans / Male Language: En Journal: Hepatol Int Year: 2022 Document type: Article