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

Table 1 Demographic, clinical and laboratory findings of the study population for Acute decompensation and Acute-on-chronic liver failure

Variable	Study population (n = 97)	AD (n = 57)	ACLF (n = 40)	ACLF grade 1 (n = 14)	ACLF grade 2 (n = 20)	ACLF grade 3 (n = 6)
Age (yr)1	56 (9)	58 (10)	54 (8.7)	52 (9.8)	55 (8.0)	53 (92.0)
Male sex2	75 (77.3)	40 (70.2)	35 (87.5)	14 (100)	17 (85)	4 (66.6)
Etiology of cirrhosis2
Alcohol	60 (61.8)	32 (56.1)	28 (70)	10 (71.4)	14 (70)	4 (66.6)
Hepatitis C	15 (15.4)	10 (17.5)	5 (12.5)	2 (14.3)	2 (10)	1 (16.6)
Alcohol and hepatitis C	13 (13.4)	9 (15.8)	4 (10)	1 (7.1)	2 (10)	2 (33.3)
Other	9 (9.2)	6 (10.5)	3 (7.5)	1 (7.1)	2 (10)	0
Active alcoholism2	45 (46.3)	24 (42)	21 (52.5)	7 (50)	11 (55)	3 (50)
Previous use of medications2
PPI	28 (28.8)	20 (35.1)	8 (20)	4 (28.6)	3 (15)	1 (16.6)
Spironolactone	16 (16.4)	5 (8.8)	11 (27.5)	3 (21.4)	6 (30)	2 (33.3)
Furosemide	16 (16.4)	4 (7)	12 (30)	4 (28.6)	6 (30)	2 (33.3)
NSBB	23 (23.7)	15 (26.3)	8 (20)	3 (21.4)	5 (25)	0
Renal replacement therapy2	2 (2)	1 (1.8)	1 (2.5)	1 (7.1)	0	0
Portal vein thrombosis2	3 (3.1)	3 (5.3)	0	0	0	0
Hepatocellular carcinoma2	9 (9.2)	6 (10.5)	3 (7.5)	1 (7.1)	1 (5)	1 (16.6)
Hepatorenal syndrome2	19 (19.5)	3 (5.3)	16 (40)	6 (14.9)	7 (35)	3 (50)
Ascites2	47 (48.4)	31 (54.4)	26 (65)	10 (71.4)	12 (60)	4 (66.6)
Hepatic encephalopathy2
Absent	72 (74.3)	46 (80.7)	26 (65)	9 (64.3)	13 (35)	4 (66.6)
Grade 1	6 (6.2)	2 (3.5)	4 (10)	3 (21.4)	1 (5)	0
Grade 2	7 (7.2)	3 (5.3)	4 (10)	2 (14.3)	2 (10)	0
Grade 3	8 (8.2)	4 (7.0)	4 (10)	0	3 (15)	1 (16.6)
Grade 4	4 (4.1)	2 (3.5)	2 (5)	0	1 (5)	1 (16.6)
Esophageal varices2
Small caliber	14 (14.5)	12 (21)	2 (5)	2 (14.2)	0	0
Medium caliber	28 (28.8)	16 (28.1)	12 (30)	6 (42.9)	6 (30)	0
Large caliber	55 (56.7)	29 (50.9)	26 (65)	6 (42.9)	14 (70)	6 (100)
Infection2
Absent	67 (69)	43 (75.4)	24 (60)	8 (57.1)	14 (70)	2 (33.3)
SBP	5 (5.1)	3 (5.3)	2 (5)	2 (14.3)	0	0
RTI	9 (9.2)	6 (10.5)	3 (7.5)	1 (7.1)	1 (5)	1 (16.6)
UTI	5 (5.1)	3 (5.3)	2 (5.0)	0	2 (10)	0
Sepsis with undefined source of infection	8 (8.2)	0	8 (20)	3 (21.4)	2 (10)	3 (50)
Other	3 (3.1)	2 (3.5)	1 (2.5)	0	1 (5)	0
Index endoscopy
Red marks2	36 (37.1)	24 (42.1)	12 (30)	4 (28.6)	5 (25)	3 (50)
Rupture point2	28 (28.8)	14 (24.6)	14 (35)	6 (42.9)	7 (35)	1 (16.6)
Active bleeding2	12 (12.3)	5 (8.8)	7 (17.5)	3 (21.4)	3 (15)	1 (16.6)
Variceal banding2	40 (41.2)	21 (36.8)	19 (47.5)	10 (71.4)	7 (35)	2 (33.3)
Esclerotherapy2	7 (7.2)	4 (7)	3 (7.5)	0	2 (10)	1 (16.6)
Door to endoscopy time (hours)1	31.2 (35.9)	29.4 (35)	35 (37)	32 (36)	39 (43)	33 (12)
Laboratory – in admission1
Hemoglobin (g/dL)	8.4 (2.4)	8.5 (2.6)	8.4 (2.8)	9.7 (2.5)	7.4 (2.0)	8.9 (4.3)
Hematocrit (%)	26.4 (19.4)	28.4 (24.9)	24.4 (7.6)	26.9 (8.0)	22.2 (5.3)	26 (11.7)
Leukocyte (/mm³)	12038 (5565)	7974 (5211)	9850 (4026)	9887 (6202)	12870 (5695)	9635 (5069)
Platelets (10³/mm³)	102 (63)	90 (55)	115 (72)	115 (76)	120 (67)	98 (88)
Total bilirubin (mg/dL)	3.2 (3.9)	2.2 (2.0)	4.7 (5.3)	2.8 (2.1)	4.2 (5.0)	10.0 (7.9)
INR	1.6 (0.6)	1.3 (0.3)	1.9 (0.8)	1.5 (0.3)	2.1 (0.9)	2.0 (0.9)
AST (U/L)	174 (303)	138 (257)	211 (351)	141 (136)	281 (473)	139 (160)
ALT (U/L)	78 (128)	70 (136)	85 (118)	84 (118)	99 (136)	42 (26)
GGT (U/L)	238 (333)	305 (366)	161 (284)	138 (101)	198 (374)	86 (68)
Creatinine (mg/dL)	1.3 (1.1)	0.8 (0.3)	1.9 (1.4)	1.3 (0.5)	2.1 (1.4)	2.8 (2.3)
Sodium (mg/dL)	136 (14)	135 (18)	138 (5)	137 (4)	139 (5)	135 (6)
Potassium (mg/dL)	5.7 (1.7)	6.7 (1.8)	4.5 (1.0)	4.3 (0.8)	4.7 (1.1)	4.2 (0.8)
Albumin (mg/dL)	2.6 (0.5)	2.7 (0.5)	2.5 (0.5)	2.4 (0.5)	2.5 (0.5)	2.7 (0.6)
CRP (mg/L)	27 (29)	23 (25)	31 (32)	3 (1)	35 (26)	47 (63)
Blood products1
Packed red blood cells (units)	5.4 (5.7)	6.1 (6.4)	4.4 (4.5)	3.8 (3.1)	4.7 (4.7)	4.8 (6.8)
Packed red blood cells (mL)	1427 (976)	1607 (1746)	1171 (1092)	1026 (823)	1212 (983)	1372 (1936)
Fresh frozen plasma (units)	4.1 (6.2)	3.4 (5.8)	5.2 (6.7)	3.4 (5.3)	6.2 (7.1)	6.5 (8.4)
Fresh frozen plasma (mL)	744 (1121)	626 (1100)	912 (1114)	621 (928)	1069 (1051)	1066 (1287)
Platelets (units)	2.7 (7.7)	2 (4.7)	4 (10.5)	4.6 (12.8)	1.6 (3.8)	9.8 (18.0)
Platelets (mL)	196 (535)	142 (349)	273 (721)	314 (816)	116 (267)	703 (1,315)
Liver-specific scores1
CTP	9 (2)	8 (2)	10 (2)	9 (2)	9 (2)	11 (2)
MELD	16 (7)	12 (5)	21 (7)	17 (4)	23 (6)	27 (10)
MELD-Na	17 (7)	13 (5)	22 (7)	18 (5)	24 (6)	27 (11)
CLIF-SOFA	8.8 (1.5)	8 (0.9)	10 (1.5)	8 (0.9)	10 (0.8)	12 (1.3)
CLIF-C AD or ACLF	49 (9.9)	17 (10.3)	50 (9.2)	46 (7)	52 (10)	56 (6)
Time to death (days)1	94 (203)	144 (243)	71 (183)	99 (156)	66 (234)	25 (51)
Treatment failure1	7 (7.2)	5 (8.8)	2 (5)	1 (7.1)	0	1 (16.6)
All-cause mortality2
30-day	35 (36)	8 (14)	27 (67.5)	8 (57.1)	14 (70)	5 (83.3)
90-day	39 (40.2)	12 (21.1)	27 (67.5)	8 (57.1)	14 (70)	5 (83.3)
365-day	48 (49.4)	17 (29.8)	31 (77.5)	12 (85)	14 (70)	6 (100)

¹mean (SD).

²Frequency (%).

AD: Acute decompensation; ACLF: Acute-on-chronic liver failure; PPI: Proton pump inhibitor; NSBB: Non-selective beta-blockers; SBP: Spontaneous bacterial peritonitis; RTI: Respiratory tract infection; UTI: Urinary tract infection; INR: International normalized ratio; AST: Aspartate transaminase; ALT: Alanine transaminase; GGT: Gamma-glutamyl transferase; CRP: C-reactive protein; CTP: Child-turcotte-pugh score; MELD: Model for end-stage liver disease; MELD-Na: Modified model including sodium; CLIF-SOFA: Chronic liver failure sequential organ failure assessment; CLIF-C AD or ACLF: CLIF Consortium acute decompensation or acute-on-chronic liver failure.