Acute-on-chronic liver failure as a major predictive factor for mortality in patients with variceal bleeding

Author:

Shin Jongbeom,Yu Jung Hwan,Jin Young-Joo,Yim Hyung Joon,Jung Young Kul,Yang Jin Mo,Song Do Seon,Kim Young Seok,Kim Sang Gyune,Kim Dong Joon,Suk Ki Tae,Yoon Eileen L.,Lee Sang Soo,Kim Chang Wook,Kim Hee Yeon,Jang Jae Young,Jeong Soung Won,

Abstract

Background/Aims: This study examined the risk factors associated with mortality in cirrhotic patients hospitalized with variceal bleeding, and evaluated the effects of acute-on-chronic liver failure (ACLF) on the prognosis of these patients.Methods: This study was retrospectively conducted on patients registered in the Korean acute-on-chronic liver failure study cohort, and on 474 consecutive cirrhotic patients hospitalized with variceal bleeding from January 2013 to December 2013 at 21 university hospitals. ACLF was defined as described by the European Association for the Study of Liver-Chronic Liver Failure Consortium.Results: Among a total of 474 patients, 61 patients were diagnosed with ACLF. The cumulative overall survival (OS) rate was lower in the patients with ACLF than in those without (<i>P</i><0.001), and patients with higher ACLF grades had a lower OS rate (<i>P</i><0.001). The chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score was identified as a significant prognostic factor in patients hospitalized with variceal bleeding (hazard ratio [HR], 1.40; 95% confidence interval [CI], 1.30–1.50; <i>P</i><0.001), even in ACLF patients with variceal bleeding (HR, 1.32; 95% CI, 1.19–1.46, <i>P</i><0.001). Concerning the prediction of the mortality risk at 28- and 90-day using CLIF-SOFA scores, c-statistics were 0.895 (95% CI, 0.829–0.962) and 0.897 (95% CI, 0.842–0.951), respectively, and the optimal cut-off values were 6.5 and 6.5, respectively.Conclusions: In cirrhotic patients hospitalized with variceal bleeding, the prognosis was poor when accompanied by ACLF, especially depending upon CLIF-SOFA score. CLIF-SOFA model well predicted the 28-day or 90-day mortality for cirrhotic patients who experienced variceal bleeding.

Funder

Inha University

Publisher

The Korean Association for the Study of the Liver

Subject

Molecular Biology,Hepatology

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