Acute-on-chronic liver failure is independently associated with higher mortality for cirrhotic patients with acute esophageal variceal hemorrhage:Retrospective cohort study  

作　　者：Alana Zulian Terres Rafael Sartori Balbinot Ana Laura Facco Muscope Morgana Luisa Longen Bruna Schena Bruna Teston Cini Gilberto Luis Rost Jr Juline Isabel Leichtweis Balensiefer Louise Zanotto Eberhardt Raul Angelo Balbinot Silvana Sartori Balbinot Jonathan Soldera 

机构地区：[1]Clinical Gastroenterology,Universidade de Caxias do Sul,Caxias do Sul 95020-002,Brazil [2]School of Medicine,Universidade de Caxias do Sul,Caxias do Sul 95020-002,Brazil [3]Department of Gastroenterology,University of South Wales,Cardiff CF371DL,United Kingdom

出　　处：《World Journal of Clinical Cases》2023年第17期4003-4018,共16页世界临床病例杂志

基　　金：This study was approved by the Research ethics committee of Universidade de Caxias do Sul on June 20,2017,under protocol no.66646617.3.0000.5341.

摘　　要：BACKGROUND Acute esophageal variceal hemorrhage(AEVH)is a common complication of cirrhosis and might precipitate multi-organ failure,causing acute-on-chronic liver failure(ACLF).AIM To analyze if the presence and grading of ACLF as defined by European Society for the Study of the Liver-Chronic Liver Failure(EASL-CLIF)is able to predict mortality in cirrhotic patients presenting AEVH.METHODS Retrospective cohort study executed in Hospital Geral de Caxias do Sul.Data from medical records from 2010 to 2016 were obtained by searching the hospital electronic database for patients who received terlipressin.Medical records were reviewed in order to determine the diagnosis of cirrhosis and AEVH,including 97 patients.Kaplan-Meier survival analysis was used for univariate analysis and a stepwise approach to the Cox regression for multivariate analysis.RESULTS All-cause mortality for AEVH patients was 36%,40.2%and 49.4%for 30-,90-and 365-day,respectively.The prevalence of ACLF was 41.3%.Of these,35%grade 1,50%grade 2 and 15%grade 3.In multivariate analysis,the non-use of non-selective beta-blockers,presence and higher grading of ACLF and higher Model for End-Stage Liver Disease scores were independently associated with higher mortality for 30-day with the addition of higher Child-Pugh scores for 90-day period.CONCLUSION Presence and grading of ACLF according to the EASL-CLIF criteria was independently associated with higher 30-and 90-day mortality in cirrhotic patients admitted due to AEVH.

关 键 词：Gastrointestinal hemorrhage Prognosis Esophageal and gastric varices Liver cirrhosis Acuteon-chronic liver failure Organ dysfunction scores 

分 类 号：R575.3[医药卫生—消化系统] R575.2[医药卫生—内科学]