Rebleeding and mortality risk are increased by ACLF but reduced by pre-emptive TIPS
Trebicka, Jonel (Institut de Bioenginyeria de Catalunya)
Gu, Wenyi (Shanghai Jiao Tong University)
Ibáñez-Samaniego, Luis (Hospital General Universitario Gregorio Marañón)
Hernández-Gea, Virginia (Centro de Investigación Biomédica Red de enfermedades hepáticas y digestivas (CIBERehd))
Pitarch, Carla (European Foundation for the Study of Chronic Liver Failure - EF CLIF)
García López, Elisabet (European Foundation for the Study of Chronic Liver Failure - EF CLIF)
Procopet, Bogdan ("Iuliu Hatieganu" University of Medicine and Pharmacy)
Giráldez-Gallego, Álvaro (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Amitrano, Lucio (Ospedale A Cardarelli)
Villanueva, Càndid (Institut d'Investigació Biomèdica Sant Pau)
Thabut, Dominique (Paris Sorbonne Université)
Silva-Junior, Gilberto (Hospital Clínic i Provincial de Barcelona)
Martinez, Javier (Hospital Universitario Ramón y Cajal (Madrid))
Genescà Ferrer, Joan (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Bureau, Cristophe (University Paul Sabatier of Toulouse)
Llop, Elba (Universidad Autónoma de Madrid)
Laleman, Wim (University Hospitals Leuven (Bèlgica))
Palazon, Jose Maria (Hospital General Universitario de Alicante (Alacant, País Valencià))
Castellote, Jose (Hospital Universitari de Bellvitge)
Rodrigues, Susana G. (Centro Hospitalar São João)
Gluud, Lise Lotte (University of Copenhagen)
Ferreira, Carlos Noronha (Hospital de Santa Maria - Centro Hospitalar Lisboa Norte)
Barcelo, Rafael (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
Cañete Hidalgo, Nuria (Institut Hospital del Mar d'Investigacions Mèdiques)
Rodriguez, Manuel (Hospital Universitario Central de Asturias)
Ferlitsch, Arnulf (Medical University of Vienna)
Mundi Sánchez-Ramade, Jose Luis (Hospital Universitario San Cecilio (Granada))
Gronbaek, Henning (Aarhus University Hospital (Aarhus, Dinamarca))
Hernandez-Guerra, Manuel (Hospital Universitario de Canarias (La Laguna))
Sassatelli, Romano (Arcispedale Santa Maria Nuova-IRCCS)
Dell'Era, Alessandra (University of the Studies of Milan)
Senzolo, Marco (University Hospital of Padova (Pàdua, Itàlia))
Abraldes, Juan G. (University of Alberta)
Romero-Gómez, Manuel (Hospital Universitario Virgen de Valme (Sevilla, Andalusia))
Zipprich, Alexander (Martin Luther University Halle-Wittenberg)
Casas, Meritxell (Universitat Autònoma de Barcelona. Departament de Medicina)
Masnou, Helena (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Primignani, Massimo (CRC "A.M.and A.Miglaivacca" Center for Liver Disease)
Weiss, Emmanuel (European Foundation for the Study of Chronic Liver Failure - EF CLIF)
Catalina, María-Vega (Hospital General Universitario Gregorio Marañón)
Erasmus, Hans Peter (University of Frankfurt)
Uschner, Frank Erhard (University of Frankfurt)
Schulz, Martin (University of Frankfurt)
Brol, Maximilian Joseph (University of Bonn)
Praktiknjo, Michael (University of Bonn)
Chang, Johannes (University of Bonn)
Krag, Aleksander (Odense University Hospital (Dinamarca))
Nevens, Frederik (University Hospitals Leuven (Bèlgica))
Calleja, Jose Luis (Universidad Autónoma de Madrid)
Robic, Marie Angèle (University Paul Sabatier of Toulouse)
Conejo, Irene (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Albillos, Agustín (Hospital Universitario Ramón y Cajal (Madrid))
Rudler, Marika (Paris Sorbonne Université)
Alvarado-Tapias, Edilmar (Institut d'Investigació Biomèdica Sant Pau)
Guardascione, Maria Anna (Ospedale A Cardarelli)
Tantau, Marcel ("Iuliu Hatieganu" University of Medicine and Pharmacy)
Bosch, Jaime (Bern University)
Torres, Ferran (Hospital Clínic i Provincial de Barcelona)
Pavesi, Marco (European Foundation for the Study of Chronic Liver Failure - EF CLIF)
García-Pagán, JC (Centro de Investigación Biomédica Red de enfermedades hepáticas y digestivas (CIBERehd))
Jansen, Christian (University of Bonn)
Bañares, Rafael (Universidad Complutense de Madrid)
Universitat Autònoma de Barcelona. Departament de Medicina

Date:	2020
Abstract:	The relationship between acute-on-chronic liver failure (ACLF) and acute variceal bleeding (AVB) is poorly understood. Specifically, the prevalence and prognosis of ACLF in the context of AVB is unclear, while the role of transjugular intrahepatic portosystemic shunt (TIPS) in the management in patients with ACLF has not been described to date. A multicenter, international, observational study was conducted in 2,138 patients from 34 centers between 2011 and 2015. ACLF was defined and graded according to the EASL-CLIF consortium definition. Placement of pre-emptive TIPS (pTIPS) was based on individual center policy. Patients were followed-up for 1 year, until death or liver transplantation. Cox regression and competing risk models (Gray's test) were used to identify independent predictors of rebleeding or mortality. At admission, 380/2,138 (17. 8%) patients had ACLF according to EASL-CLIF criteria (grade 1: 38. 7%; grade 2: 39. 2%; grade 3: 22. 1%). The 42-day rebleeding (19% vs. 10%; p <0. 001) and mortality (47% vs. 10%; p <0. 001) rates were higher in patients with ACLF and increased with ACLF grades. Of note, the presence of ACLF was independently associated with rebleeding and mortality. pTIPS placement improved survival in patients with ACLF at 42 days and 1 year. This effect was also observed in propensity score matching analysis of 66 patients with ACLF, of whom 44 received pTIPs and 22 did not. This large multicenter international real-life study identified ACLF at admission as an independent predictor of rebleeding and mortality in patients with AVB. Moreover, pTIPS was associated with improved survival in patients with ACLF and AVB. Lay summary: Acute variceal bleeding is a deadly complication of liver cirrhosis that results from severe portal hypertension. This study demonstrates that the presence of acute-on-chronic liver failure (ACLF) is the strongest predictor of mortality in patients with acute variceal bleeding. Importantly, patients with ACLF and acute variceal (re)bleeding benefit from pre-emptive (early) placement of a transjugular intrahepatic portosystemic shunt.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Acute variceal bleeding ; Acute-on-chronic liver failure ; Cirrhosis ; Rebleeding
Published in:	Journal of Hepatology, Vol. 73 Núm. 5 (november 2020) , p. 1082-1091, ISSN 1600-0641

DOI: 10.1016/j.jhep.2020.04.024
PMID: 32339602

11 p, 767.6 KB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
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