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Determinants of mortality in patients with cirrhosis and uncontrolled variceal bleeding

Kumar, R; Kerbert, AJC; Sheikh, MF; Roth, N; Calvao, JAF; Mesquita, MD; Barreira, AI; ... Jalan, R; + view all (2021) Determinants of mortality in patients with cirrhosis and uncontrolled variceal bleeding. Journal of Hepatology , 74 (1) pp. 66-79. 10.1016/j.jhep.2020.06.010. Green open access

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Abstract

BACKGROUND AND AIM: Failure to control oesophago-gastric variceal bleeding (OGVB) and acute-on-chronic liver failure (ACLF) are both important prognostic factors in liver cirrhosis. The aims of this study were to determine whether ACLF and its severity define the risk of death in OGVB and whether insertion of rescue transjugular intrahepatic stent-shunt (TIPSS) improves the survival of patients with failure to control OGVB and ACLF. METHODS: From a prospectively maintained ICU registry, data of 174 consecutive eligible patients with failure to control OGVB between 2005 and 2015, were included. Rescue TIPSS was defined as technically successful TIPSS within 72-hours of presentation with failure to control OGVB. Cox proportional hazards regression analyses were applied to explore the impact of ACLF and TIPSS on survival in failure-to-control OGVB. RESULTS: ACLF patients (n=119) were significantly older, had organ failures and higher white cell count compared with patients with acute decompensation (AD, n=55). Mortality at 42-days and 1-year was significantly higher in ACLF (47.9% and 61.3%) as compared to AD patients (9.1% and 12.7%, p<0.001), whereas there was no difference in the number of endoscopies and transfusion requirements between these groups. TIPSS was inserted in 78 patients [AD: 21 (38.2%); ACLF: 57 (47.8%), p=0.41]. In ACLF, rescue TIPSS insertion was an independent favorable prognostic factor for 42-day mortality. In contrast, rescue TIPSS did not impact on the outcome of AD patients. CONCLUSIONS: This study shows for the first time that in patients with failure to control OGVB, the presence and severity of ACLF determines the risk of 42-day and 1-year mortality. Rescue TIPSS is associated with improved survival of ACLF patients.

Type: Article
Title: Determinants of mortality in patients with cirrhosis and uncontrolled variceal bleeding
Location: Netherlands
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.jhep.2020.06.010
Publisher version: https://doi.org/10.1016/j.jhep.2020.06.010
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Acute Oesophago-gastric variceal bleeding, Acute on chronic liver failure, Transjugular intrahepatic portosystemic shunt
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inst for Liver and Digestive Hlth
URI: https://discovery.ucl.ac.uk/id/eprint/10102344
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