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)

APASL ACLF Research Consortium (AARC) for APASL ACLF working Party.

doi:10.1007/s12072-022-10372-1

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)

APASL ACLF Research Consortium (AARC) for APASL ACLF working Party.

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

12 Citations (Scopus)

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.

Original language	English
Pages (from-to)	1234-1243
Number of pages	10
Journal	Hepatology International
Volume	16
Issue number	5
DOIs	https://doi.org/10.1007/s12072-022-10372-1
Publication status	Published - Oct 2022

Keywords

Acute variceal bleeding
Alcoholic hepatitis
Hepatic failure
Hepatic venous pressure gradient
Infections
Organ failure
Portal hypertension
Portal pressure
Rebleeding
Varices

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1007/s12072-022-10372-1

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@article{50772f1ba74747418d0a60705373f791,

title = "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)",

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.",

keywords = "Acute variceal bleeding, Alcoholic hepatitis, Hepatic failure, Hepatic venous pressure gradient, Infections, Organ failure, Portal hypertension, Portal pressure, Rebleeding, Varices",

author = "{APASL ACLF Research Consortium (AARC) for APASL ACLF working Party.} and Sanchit Sharma and Samagra Agarwal and Anoop Saraya and Ashok Choudhury and Mahtab, {Mamun Al} and Alam, {Mohd Shahinul} and Sanjiv Saigal and Kim, {Dong Joon} and Eapen, {C. E.} and Ashish Goel and Qin Ning and Harshad Devarbhavi and Virendra Singh and Akash Shukla and Saeed Hamid and Jinhua Hu and Tan, {Soek Siam} and Anil Arora and Sahu, {Manoj Kumar} and Mohd Rela and Dinesh Jothimani and Rao, {P. N.} and Anand Kulkarni and Hashmik Ghaznian and Lee, {Guan Huei} and Duan Zhongping and Ajit Sood and Omesh Goyal and Lesmana, {Laurentius A.} and Lesmana, {Rinaldi C.} and Sombat Treeprasertsuk and Nan Yuemin and Samir Shah and Han Tao and Dayal, {V. M.} and Xin Shaojie and Fazal Karim and Zaigham Abbas and Sollano, {Jose D.} and Kalista, {Kemal Fariz} and Ananta Shreshtha and Diana Payawal and Masao Omata and Sarin, {Shiv Kumar} and Sarin, {Shiv Kumar} and Ashok Choudhury and Sharma, {Manoj K.} and Rakhi Maiwall and {Al Mahtab}, Mamun and Rino Gani",

note = "Publisher Copyright: {\textcopyright} 2022, Asian Pacific Association for the Study of the Liver.",

year = "2022",

month = oct,

doi = "10.1007/s12072-022-10372-1",

language = "English",

volume = "16",

pages = "1234--1243",

journal = "Hepatology International",

issn = "1936-0533",

publisher = "Springer",

number = "5",

}

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). / APASL ACLF Research Consortium (AARC) for APASL ACLF working Party.
In: Hepatology International, Vol. 16, No. 5, 10.2022, p. 1234-1243.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Acute variceal bleeding portends poor outcomes in patients with acute-on-chronic liver failure

T2 - a propensity score matched study from the APASL ACLF Research Consortium (AARC)

AU - APASL ACLF Research Consortium (AARC) for APASL ACLF working Party.

AU - Sharma, Sanchit

AU - Agarwal, Samagra

AU - Saraya, Anoop

AU - Choudhury, Ashok

AU - Mahtab, Mamun Al

AU - Alam, Mohd Shahinul

AU - Saigal, Sanjiv

AU - Kim, Dong Joon

AU - Eapen, C. E.

AU - Goel, Ashish

AU - Ning, Qin

AU - Devarbhavi, Harshad

AU - Singh, Virendra

AU - Shukla, Akash

AU - Hamid, Saeed

AU - Hu, Jinhua

AU - Tan, Soek Siam

AU - Arora, Anil

AU - Sahu, Manoj Kumar

AU - Rela, Mohd

AU - Jothimani, Dinesh

AU - Rao, P. N.

AU - Kulkarni, Anand

AU - Ghaznian, Hashmik

AU - Lee, Guan Huei

AU - Zhongping, Duan

AU - Sood, Ajit

AU - Goyal, Omesh

AU - Lesmana, Laurentius A.

AU - Lesmana, Rinaldi C.

AU - Treeprasertsuk, Sombat

AU - Yuemin, Nan

AU - Shah, Samir

AU - Tao, Han

AU - Dayal, V. M.

AU - Shaojie, Xin

AU - Karim, Fazal

AU - Abbas, Zaigham

AU - Sollano, Jose D.

AU - Kalista, Kemal Fariz

AU - Shreshtha, Ananta

AU - Payawal, Diana

AU - Omata, Masao

AU - Sarin, Shiv Kumar

AU - Choudhury, Ashok

AU - Sharma, Manoj K.

AU - Maiwall, Rakhi

AU - Al Mahtab, Mamun

AU - Gani, Rino

PY - 2022/10

Y1 - 2022/10

N2 - 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.

AB - 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.

KW - Acute variceal bleeding

KW - Alcoholic hepatitis

KW - Hepatic failure

KW - Hepatic venous pressure gradient

KW - Infections

KW - Organ failure

KW - Portal hypertension

KW - Portal pressure

KW - Rebleeding

KW - Varices

UR - http://www.scopus.com/inward/record.url?scp=85134544298&partnerID=8YFLogxK

U2 - 10.1007/s12072-022-10372-1

DO - 10.1007/s12072-022-10372-1

M3 - Article

AN - SCOPUS:85134544298

SN - 1936-0533

VL - 16

SP - 1234

EP - 1243

JO - Hepatology International

JF - Hepatology International

IS - 5

ER -

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)

Abstract

Keywords

UN SDGs

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