Acute-on-chronic liver failure as a major predictive factor for mortality in patients with variceal bleeding

被引：25

作者：

Shin, Jongbeom ^{[1
]}

Yu, Jung Hwan ^{[1
]}

Jin, Young-Joo ^{[1
]}

Yim, Hyung Joon ^{[2
]}

Jung, Young Kul ^{[2
]}

Yang, Jin Mo ^{[3
]}

Song, Seon ^{[3
]}

Kim, Young Seok ^{[4
]}

Kim, Sang Gyune ^{[4
]}

Kim, Dong Joon ^{[5
,6
]}

Suk, Ki Tae ^{[5
,6
]}

Yoon, Eileen L. ^{[7
]}

Lee, Sang Soo ^{[8
]}

Kim, Chang Wook ^{[9
]}

Kim, Hee Yeon ^{[9
]}

Jang, Jae Young ^{[10
,11
]}

Jeong, Soung Won ^{[10
,11
]}

机构：

[1] Inha Univ, Inha Univ Hosp, Dept Internal Med, Sch Med, 27 Inhang Ro, Incheon 22332, South Korea

[2] Korea Univ Ansan Hosp, Dept Internal Med, Div Gastroenterol & Hepatol, Ansan, South Korea

[3] Catholic Univ Korea, St Vincents Hosp, Dept Internal Med, Coll Med, Seoul, South Korea

[4] Soonchunhyang Univ Hosp Bucheon, Dept Internal Med, Bucheon, South Korea

[5] Hallym Univ, Inst Liver & Digest Dis, Chunchon, South Korea

[6] Hallym Univ, Coll Med, Dept Internal Med, Chunchon, South Korea

[7] Inje Univ, Sanggye Paik Hosp, Dept Internal Med, Div Gastroenterol & Hepatol,Coll Med, Seoul, South Korea

[8] Gyeongsang Natl Univ, Changwon Hosp, Dept Internal Med, Sch Med, Chang Won, South Korea

[9] Catholic Univ Korea, Uijeongbu St Marys Hosp, Dept Internal Med, Coll Med, Seoul, South Korea

[10] Soonchunhyang Univ, Soonchunhyang Univ Hosp, Coll Med, Inst Digest Res, Seoul, South Korea

[11] Soonchunhyang Univ, Soonchunhyang Univ Hosp, Coll Med, Digest Dis Ctr,Dept Internal Med, Seoul, South Korea

来源：

CLINICAL AND MOLECULAR HEPATOLOGY | 2020年 / 26卷 / 04期

关键词：

Acute-on; chronic liver failure; Variceal bleeding; Prognosis; Sequential organ failure assessment; ALCOHOLIC CIRRHOTIC-PATIENTS; VENOUS-PRESSURE GRADIENT; SHORT-TERM; CLINICAL-COURSE; SCLEROTHERAPY; HEMORRHAGE; MANAGEMENT; PROGNOSIS; LIGATION; SURVIVAL;

D O I：

10.3350/cmh.2020.0034

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background/Aims: This study examined the risk factors associated with mortality in cirrhotic patients hospitalized with variceal bleeding, and evaluated the effects of acute-on-chronic liver failure (ACLF) on the prognosis of these patients. Methods: This study was retrospectively conducted on patients registered in the Korean acute- on-chronic liver failure study cohort, and on 474 consecutive cirrhotic patients hospitalized with variceal bleeding from January 2013 to December 2013 at 21 university hospitals. ACLF was defined as described by the European Association for the Study of Liver-Chronic Liver Failure Consortium. Results: Among a total of 474 patients, 61 patients were diagnosed with ACLF. The cumulative overall survival (OS) rate was lower in the patients with ACLF than in those without (P<0.001), and patients with higher ACLF grades had a lower OS rate (P<0.001). The chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score was identified as a significant prognostic factor in patients hospitalized with variceal bleeding (hazard ratio [HR], 1.40; 95% confidence interval [CI], 1.30-1.50; P<0.001), even in ACLF patients with variceal bleeding (HR, 1.32; 95% CI, 1.19-1.46, P<0.001). Concerning the prediction of the mortality risk at 28- and 90-day using CLIF-SOFA scores, c-statistics were 0.895 (95% CI, 0.829-0.962) and 0.897 (95% CI, 0.842- 0.951), respectively, and the optimal cut-off values were 6.5 and 6.5, respectively. Conclusions: In cirrhotic patients hospitalized with variceal bleeding, the prognosis was poor when accompanied by ACLF, especially depending upon CLIF-SOFA score. CLIF-SOFA model well predicted the 28- day or 90-day mortality for cirrhotic patients who experienced variceal bleeding.

引用

页码：540 / 553

页数：14

共 37 条

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