Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jun 16;11(17):4003-4018.
doi: 10.12998/wjcc.v11.i17.4003.

Acute-on-chronic liver failure is independently associated with higher mortality for cirrhotic patients with acute esophageal variceal hemorrhage: Retrospective cohort study

Alana Zulian Terres  1 , Rafael Sartori Balbinot  2 , Ana Laura Facco Muscope  2 , Morgana Luisa Longen  2 , Bruna Schena  2 , Bruna Teston Cini  2 , Gilberto Luis Rost Jr  2 , Juline Isabel Leichtweis Balensiefer  2 , Louise Zanotto Eberhardt  2 , Raul Angelo Balbinot  1 , Silvana Sartori Balbinot  1 , Jonathan Soldera  3
Affiliations

Acute-on-chronic liver failure is independently associated with higher mortality for cirrhotic patients with acute esophageal variceal hemorrhage: Retrospective cohort study

Alana Zulian Terres et al. World J Clin Cases. .

Abstract

Background: Acute esophageal variceal hemorrhage (AEVH) is a common complication of cirrhosis and might precipitate multi-organ failure, causing acute-on-chronic liver failure (ACLF).

Aim: To analyze if the presence and grading of ACLF as defined by European Society for the Study of the Liver-Chronic Liver Failure (EASL-CLIF) is able to predict mortality in cirrhotic patients presenting AEVH.

Methods: Retrospective cohort study executed in Hospital Geral de Caxias do Sul. Data from medical records from 2010 to 2016 were obtained by searching the hospital electronic database for patients who received terlipressin. Medical records were reviewed in order to determine the diagnosis of cirrhosis and AEVH, including 97 patients. Kaplan-Meier survival analysis was used for univariate analysis and a stepwise approach to the Cox regression for multivariate analysis.

Results: All- cause mortality for AEVH patients was 36%, 40.2% and 49.4% for 30-, 90- and 365-day, respectively. The prevalence of ACLF was 41.3%. Of these, 35% grade 1, 50% grade 2 and 15% grade 3. In multivariate analysis, the non-use of non-selective beta-blockers, presence and higher grading of ACLF and higher Model for End-Stage Liver Disease scores were independently associated with higher mortality for 30-day with the addition of higher Child-Pugh scores for 90-day period.

Conclusion: Presence and grading of ACLF according to the EASL-CLIF criteria was independently associated with higher 30- and 90-day mortality in cirrhotic patients admitted due to AEVH.

Keywords: Acute-on-chronic liver failure; Esophageal and gastric varices; Gastrointestinal hemorrhage; Liver cirrhosis; Organ dysfunction scores; Prognosis.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest statement: The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Evidence-based protocol for diagnosis and treatment of acute esophageal variceal hemorrhage.
Figure 2
Figure 2
Flowchart for the study population and mortality for acute esophageal variceal hemorrhage patients according to the presence of acute decompensation or acute-on-chronic liver failure and each grade. AD: Acute decompensation; ACLF: Acute-on-chronic liver failure; AEVH: Acute esophageal variceal hemorrhage.
Figure 3
Figure 3
Kaplan-Meier curves for 28- and 90-day survival for acute decompensation or acute-on-chronic liver failure and each grade. AD: Acute decompensation; ACLF: Acute-on-chronic liver failure.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Berzigotti A, Seijo S, Reverter E, Bosch J. Assessing portal hypertension in liver diseases. Expert Rev Gastroenterol Hepatol . 2013;7:141–155. - PubMed
    1. Gracia-Sancho J, Maeso-Díaz R, Bosch J. Pathophysiology and a Rational Basis of Therapy. Dig Dis . 2015;33:508–514. - PubMed
    1. Iwakiri Y, Groszmann RJ. The hyperdynamic circulation of chronic liver diseases: from the patient to the molecule. Hepatology . 2006;43:S121–S131. - PubMed
    1. Boregowda U, Umapathy C, Halim N, Desai M, Nanjappa A, Arekapudi S, Theethira T, Wong H, Roytman M, Saligram S. Update on the management of gastrointestinal varices. World J Gastrointest Pharmacol Ther . 2019;10:1–21. - PMC - PubMed
    1. Tsochatzis EA, Bosch J, Burroughs AK. Liver cirrhosis. Lancet . 2014;383:1749–1761. - PubMed