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; Rafael Sartori Balbinot; Ana Laura Facco Muscope; Morgana Luisa Longen; Bruna Schena; Bruna Teston Cini; Gilberto Luis Rost Jr; Juline Isabel Leichtweis Balensiefer; Louise Zanotto Eberhardt; Raul Angelo Balbinot; Silvana Sartori Balbinot; Jonathan Soldera

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

World J Clin Cases. 2023 Jun 16;11(17):4003-4018. doi: 10.12998/wjcc.v11.i17.4003.

Affiliations

¹ Clinical Gastroenterology, Universidade de Caxias do Sul, Caxias do Sul 95020-002, Brazil.
² School of Medicine, Universidade de Caxias do Sul, Caxias do Sul 95020-002, Brazil.
³ Department of Gastroenterology, University of South Wales, Cardiff CF37 1DL, United Kingdom. jonathansoldera@gmail.com.

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.