Sanchit Sharma1, Samagra Agarwal1, Anoop Saraya2, Shiv Kumar Sarin3, Ashok Choudhury4, Mamun Al Mahtab5, Mohd Shahinul Alam5, Sanjiv Saigal6, Dong Joon Kim7, C E Eapen8, Ashish Goel8, Qin Ning9, Harshad Devarbhavi10, Virendra Singh11, Akash Shukla12, Saeed Hamid13, Jinhua Hu14, Soek-Siam Tan15, Anil Arora16, Manoj Kumar Sahu17, Mohd Rela18, Dinesh Jothimani18, P N Rao19, Anand Kulkarni19, Hashmik Ghaznian20, Guan Huei Lee21, Duan Zhongping22, Ajit Sood23, Omesh Goyal23, Laurentius A Lesmana24, Rinaldi C Lesmana24, Sombat Treeprasertsuk25, Nan Yuemin26, Samir Shah27, Han Tao28, V M Dayal29, Xin Shaojie30, Fazal Karim31, Zaigham Abbas32, Jose D Sollano33, Kemal Fariz Kalista34, Ananta Shreshtha35, Diana Payawal36, Masao Omata37. 1. Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110029, India. 2. Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110029, India. ansaraya@yahoo.com. 3. Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India. shivsarin@gmail.com. 4. Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India. 5. Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. 6. Department of Hepatology, Medanta The Medicity, Gurgaon, India. 7. Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea. 8. Department of Hepatology, Christan Medical College, Vellore, India. 9. Department of Medicine, Tongji Hospital, Tongji Medical College, Wuhan, China. 10. Department of Hepatology, St Johns Medical College, Bangalore, India. 11. 9Department of Hepatology, PGIMER, Chandigarh, India. 12. LTMMC, Mumbai, India. 13. Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan. 14. Department of Medicine, Military Hospital, Beijing, 302, China. 15. Department of Medicine, Hospital Selayang, Bata Cabs, Selangor, Malaysia. 16. Department of Gastroenterology, Sir Ganga Ram Hospital and GRIPMER, Delhi, India. 17. Department of Hepatology, IMS and SUM Hospital, Bhubaneshwar, Odisha, India. 18. Department of Liver Transplant Surgery, Dr. Rela Institute and Medical Centre, Chennai, India. 19. Asian Institute of Gastroenterology, Hyderabad, India. 20. Department of Hepatology, Nork Clinical Hospital of Infectious Disease, Yerevan, Armenia. 21. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. 22. Translational Hepatology Institute Capital Medical University, Beijing You' an Hospital, Beijing, China. 23. Department of Gastroenterology, Dayanand Medical College, Ludhiana, India. 24. Department of Medicine, Medistra Hospital, Jakarta, Indonesia. 25. Department of Medicine, Chulalongkorn University, Bangkok, Thailand. 26. Hebei Medical University, Shijiazhuang, China. 27. Department of Hepatology, Global Hospital, Mumbai, India. 28. Tianjin Institute of Hepatobiliary Disease, Tianjin, China. 29. IGIMS, Patna, India. 30. Medical School of Chinese PLA, Beijing, China. 31. Department of Hepatology, Sir Salimullah Medical College, Dhaka, Bangladesh. 32. Department of Medicine, Ziauddin University Hospital, Karachi, Pakistan. 33. Department of Medicine, University of Santo Tomas, Manila, Philippines. 34. Division of Hepetobiliary, Cipto Mangunkusuamo Hospital, University of Indonesia, Jakarta, Indonesia. 35. Department of Hepatology, Foundation Nepal, Sitapaila Height, Kathmandu, Nepal. 36. Department of Medicine, Cardinal Santos Medical Center, Metro Manila, Philippines. 37. Department of Hepatology, Yamanashi Central and Kita Hospitals, University of Tokyo, Tokyo, Japan.
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 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. 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.
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 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. 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.
Authors: Salvador Augustin; Laura Muntaner; José T Altamirano; Antonio González; Esteban Saperas; Joan Dot; Monder Abu-Suboh; Josep R Armengol; Joan R Malagelada; Rafael Esteban; Jaime Guardia; Joan Genescà Journal: Clin Gastroenterol Hepatol Date: 2009-08-21 Impact factor: 11.382
Authors: Rahul Kumar; Annarein J C Kerbert; M Faisal Sheikh; Noam Roth; Joana A F Calvao; Monica D Mesquita; Ana I Barreira; Haqeeqat S Gurm; Komal Ramsahye; Rajeshwar P Mookerjee; Dominic Yu; Neil H Davies; Gautam Mehta; Banwari Agarwal; David Patch; Rajiv Jalan Journal: J Hepatol Date: 2020-06-16 Impact factor: 25.083