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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)

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收录情况： ◇ SCIE

作者：
Sharma, Sanchit[1] * ; Agarwal, Samagra[1] ; Saraya, Anoop[1] ; Choudhury, Ashok[2] ; Al Mahtab, Mamun[3] ; Alam, Mohd Shahinul[3] ; Saigal, Sanjiv[4] ; Kim, Dong Joon[5] ; Eapen, C. E.[6] ; Goel, Ashish[6] ; Qin Ning[7] ; Devarbhavi, Harshad[8] ; Singh, Virendra[9] ; Shukla, Akash[10] ; Hamid, Saeed[11] ; Hu, Jinhua[12] ; Tan, Soek-Siam[13] ; Arora, Anil[14,15] ; Sahu, Manoj Kumar[16,17] ; Rela, Mohd[18] ; Jothimani, Dinesh[18] ; Rao, P. N.[19] ; Kulkarni, Anand[19] ; Ghaznian, Hashmik[20] ; Lee, Guan Huei[21] ; Duan Zhongping[22] ; Sood, Ajit[23] ; Goyal, Omesh[23] ; Lesmana, Laurentius A.[24] ; Lesmana, Rinaldi C.[24] ; Treeprasertsuk, Sombat[25] ; Nan Yuemin[26] ; Shah, Samir[27] ; Han Tao[28] ; Dayal, V. M.[29] ; Xin Shaojie[30] ; Karim, Fazal[31] ; Abbas, Zaigham[32] ; Sollano, Jose D.[33] ; Kalista, Kemal Fariz[34] ; Shreshtha, Ananta[35] ; Payawal, Diana[36] ; Omata, Masao[37] ; Sarin, Shiv Kumar[2] ;
单位： [1]All India Inst Med Sci, Dept Gastroenterol & Human Nutr, New Delhi 110029, India [2]Inst Liver & Biliary Sci, Dept Hepatol, New Delhi 110070, India [3]Bangabandhu Sheikh Mujib Med Univ, Dept Hepatol, Dhaka, Bangladesh [4]Medanta Medicity, Dept Hepatol, Gurgaon, India [5]Hallym Univ, Dept Internal Med, Coll Med, Seoul, South Korea [6]Christan Med Coll, Dept Hepatol, Vellore, Tamil Nadu, India [7]Tongji Hosp, Tongji Med Coll, Dept Med, Wuhan, Peoples R China [8]St Johns Med Coll, Dept Hepatol, Bangalore, Karnataka, India [9]PGIMER, Dept Hepatol, Chandigarh, India [10]LTMMC, Mumbai, Maharashtra, India [11]Aga Khan Univ Hosp, Dept Med, Karachi, Pakistan [12]Mil Hosp, Dept Med, Beijing 302, Peoples R China [13]Hosp Selayang, Dept Med, Bata Cabs, Selangor, Malaysia [14]Sir Ganga Ram Hosp, Dept Gastroenterol, Delhi, India [15]GRIPMER, Delhi, India [16]IMS, Dept Hepatol, Bhubaneswar, Odisha, India [17]SUM Hosp, Bhubaneswar, Odisha, India [18]Dr Rela Inst & Med Ctr, Dept Liver Transplant Surg, Chennai, Tamil Nadu, India [19]Asian Inst Gastroenterol, Hyderabad, India [20]Nork Clin Hosp Infect Dis, Dept Hepatol, Yerevan, Armenia [21]Natl Univ Singapore, Yong Loo Lin Sch Med, Dept Med, Singapore, Singapore [22]Capital Med Univ, Beijing You Hosp, Translat Hepatol Inst, Beijing, Peoples R China [23]Dayanand Med Coll, Dept Gastroenterol, Ludhiana, Punjab, India [24]Medistra Hosp, Dept Med, Jakarta, Indonesia [25]Chulalongkorn Univ, Dept Med, Bangkok, Thailand [26]Hebei Med Univ, Shijiazhuang, Hebei, Peoples R China [27]Global Hosp, Dept Hepatol, Mumbai, Maharashtra, India [28]Tianjin Inst Hepatobiliary Dis, Tianjin, Peoples R China [29]IGIMS, Patna, Bihar, India [30]Med Sch Chinese PLA, Beijing, Peoples R China [31]Sir Salimullah Med Coll, Dept Hepatol, Dhaka, Bangladesh [32]Ziauddin Univ Hosp, Dept Med, Karachi, Pakistan [33]Univ Santo Tomas, Dept Med, Manila, Philippines [34]Univ Indonesia, Cipto Mangunkusuamo Hosp, Div Hepetobiliary, Jakarta, Indonesia [35]Fdn Nepal, Dept Hepatol, Kathmandu, Nepal [36]Cardinal Santos Med Ctr, Dept Med, Manila, Philippines [37]Univ Tokyo, Yamanashi Cent & Kita Hosp, Dept Hepatol, Tokyo, Japan
出处：
DOI： 10.1007/s12072-022-10372-1
ISSN：

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

摘要：
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.

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中科院(CAS)分区：
出版当年[2021]版：
大类 | 2 区 医学
小类 | 2 区 胃肠肝病学
最新[2025]版：
大类 | 1 区 医学
小类 | 2 区 胃肠肝病学
JCR分区：
出版当年[2020]版：
Q2 GASTROENTEROLOGY & HEPATOLOGY
最新[2023]版：
Q1 GASTROENTEROLOGY & HEPATOLOGY

影响因子： 最新[2023版] 最新五年平均 出版当年[2020版] 出版当年五年平均 出版前一年[2019版] 出版后一年[2021版]

第一作者：
第一作者单位： [1]All India Inst Med Sci, Dept Gastroenterol & Human Nutr, New Delhi 110029, India
通讯作者：
推荐引用方式(GB/T 7714)：
Sharma Sanchit,Agarwal Samagra,Saraya Anoop,et al.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)[J].HEPATOLOGY INTERNATIONAL.2022,16(5):1234-1243.doi:10.1007/s12072-022-10372-1.
APA：
Sharma, Sanchit,Agarwal, Samagra,Saraya, Anoop,Choudhury, Ashok,Al Mahtab, Mamun...&Sarin, Shiv Kumar.(2022).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).HEPATOLOGY INTERNATIONAL,16,(5)
MLA：
Sharma, Sanchit,et al."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)".HEPATOLOGY INTERNATIONAL 16..5(2022):1234-1243

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