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

Clinical and Molecular Hepatology 2020년 26권 4호 p.540 ~ 553
Shin Jong-Beom, 유정환, 진영주, 임형준, 정영걸, 양진모, 송도선, 김영석, 김상균, 김동준, 석기태, Yoon Eileen L., 이상수, 김창욱, 김희연, 장재영,
소속 상세정보
 ( Shin Jong-Beom ) - Inha University School of Medicine Inha University Hospital Department of Internal Medicine
유정환 ( Yu Jung-Hwan ) - Inha University School of Medicine Inha University Hospital Department of Internal Medicine
진영주 ( Jin Young-Joo ) - Inha University School of Medicine Inha University Hospital Department of Internal Medicine
임형준 ( Yim Hyung-Joon ) - Korea University Ansan Hospital Department of Internal Medicine
정영걸 ( Jung Young-Kul ) - Korea University Ansan Hospital Department of Internal Medicine
양진모 ( Yang Jin-Mo ) - Catholic University College of Medicine St. Vincent’s Hospital Department of Internal Medicine
송도선 ( Song Do-Seon ) - Catholic University College of Medicine St. Vincent’s Hospital Department of Internal Medicine
김영석 ( Kim Young-Seok ) - Soonchunhyang University Bucheon Hospital Department of Internal Medicine
김상균 ( Kim Sang-Gyune ) - Soonchunhyang University Bucheon Hospital Department of Internal Medicine
김동준 ( Kim Dong-Joon ) - Hallym University College of Medicine Department of Internal Medicine
석기태 ( Suk Ki-Tae ) - Hallym University College of Medicine Department of Internal Medicine
 ( Yoon Eileen L. ) - Inje University College of Medicine Sanggye Paik Hospital Department of Internal Medicine
이상수 ( Lee Sang-Soo ) - Gyeongsang National University School of Medicine Gyeongsang National University Changwon Hospital Department of Internal Medicine
김창욱 ( Kim Chang-Wook ) - Catholic University College of Medicine Uijeongbu St. Mary’s Hospital Department of Internal Medicine
김희연 ( Kim Hee-Yeon ) - Catholic University College of Medicine Uijeongbu St. Mary’s Hospital Department of Internal Medicine
장재영 ( Jang Jae-Young ) - Soonchunhyang University College of Medicine Soonchunhyang University Hospital Department of Internal Medicine

Abstract


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.

키워드

Acute-on-chronic liver failure; Variceal bleeding; Prognosis; Sequential organ failure assessment

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