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

doi:10.12998/wjcc.v11.i17.4003

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World Journal of Clinical Cases

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Clin Cases. Jun 16, 2023; 11(17): 4003-4018
Published online Jun 16, 2023. doi: 10.12998/wjcc.v11.i17.4003

Table 2 Univariate analysis for 30- and 90-day mortality

Variable	Hazard ratio (95%CI)
Variable	30-day mortality	90-day mortality
Age (yr)¹	0.98 (0.95-1.02), P = 0.42	0.98 (0.95-1.01), P = 0.36
Male sex	1.04 (0.47-2.29), P = 0.90	1.05 (0.50-2.20), P = 0.88
Etiology of cirrhosis	0.48 (0.22-1.01), P =0.055	0.51 (0.25-1.02), P = 0.06
Active alcoholism	1.39 (0.73-2.66), P = 0.31	1.19 (0.65-2.19), P = 0.55
Previous use of medications
PPI	0.44 (0.18-1.07), P = 0.072	0.53 (0.24-1.15), P = 0.10
Spironolactone	1.18 (0.51-2.69), P = 0.69	1.22 (0.56-2.64), P = 0.60
Furosemide	1.21 (0.53-2.76), P = 0.64	1.05 (0.46-2.37), P = 0.89
NSBB	0.33 (0.12-0.95), P = 0.04	0.45 (0.19-1.07), P = 0.07
Renal replacement therapy	1.21 (0.16-8.87), P = 0.84	1.10 (0.15-8.03), P = 0.92
Portal vein thrombosis	0.04 (0.001-39.9), P = 0.37	0.99 (0.24-4.11), P = 0.99
Hepatocellular carcinoma	1.15 (0.41-3.27), P = 0.78	1.29 (0.50-3.29), P = 0.59
Hepatic encephalopathy	2.03 (1.04-3.96), P = 0.03	1.73 (0.91-3.30), P = 0.09
Treatment failure	1.05 (0.24-4.51), P = 0.94	0.84 (0.19-3.55), P = 0.81
Index endoscopy
Red marks	0.44 (0.17-1.15), P = 0.09	0.39 (0.16-0.94), P = 0.03
Rupture point	1.75 (0.74-4.12), P = 0.20	1.68 (0.78-3.65), P = 0.18
Active bleeding	2.65 (1.02-6.84), P = 0.043	2.08 (0.83-5.19), P = 0.11
Variceal banding or sclerotherapy	0.28 (0.09-0.84), P = 0.02	0.43 (0.18-1.03), P = 0.06
Esophageal varices caliber	1.14 (0.48-2.70), P = 0.75	0.93 (0.43-2.04), P = 0.87
Infection
SBP	0.97 (0.13-7.26), P = 0.98	1.19 (0.168.78), P = 0.86
RTI	0.01 (0.001-1.70), P = 0.97	0.01 (0.001-1.30), P = 0.97
UTI	1.64 (0.19-14.04), P = 0.65	1.72 (0.20-14.80), P = 0.61
Sepsis with undefined source of infection	0.55 (0.03-8.89), P = 0.67	0.54 (0.03-8.74), P = 0.67
Other	6.49 (0.79-85.86), P = 0.08	7.62 (0.93-62.41), P = 0.05
Laboratory
Hemoglobin < 9 g/dL	1.25 (0.65-2.39), P = 0.49	1.23 (0.67-2.26), P = 0.50
Leukocyte > 10000/mm³	0.50 (0.26-0.97), P = 0.04	0.50 (0.27-0.93), P = 0.03
Total bilirubin > 2 mg/dL	0.37 (0.18-0.75), P = 0.005	0.40 (0.21-0.78), P = 0.008
INR > 1.3¹	0.31 (0.13-0.72), P = 0.006	0.35 (0.21-0.78), P = 0.006
AST > 40 U/L	0.66 (0.27-1.60), P = 0.35	0.59 (0.24-1.42), P = 0.24
ALT > 40 U/L	67 (0.34-1.34), P = 0.26	0.72 (0.37-1.39), P = 0.33
GGT > 60 U/L	1.04 (0.43-2.49), P = 0.91	0.99 (0.44-2.23), P = 0.99
Creatinine > 2 mg/dL	0.50 (0.25-0.98), P = 0.046	0.52 (0.27-1.00), P = 0.05
Sodium > 135 mg/dL	0.64 (0.30-1.33), P = 0.23	0.51 (0.26-1.00), P = 0.052
Potassium > 3.5 mg/dL	1.61 (0.38-6.7), P = 0.50	1.88 (0.45-7.82), P = 0.38
Albumin > 3.5 mg/dL	0.40 (0.16-0.99), P = 0.048	0.39 (0.17-0.89), P = 0.02
Terlipressin – total dose (mg)	1.04 (0.94-1.15), P = 0.43	1.05 (0.95-1.15), P = 0.30
Blood products (used versus not used)
Packed red blood cells	0.61 (0.28-1.3), P = 0.22	0.61 (0.29-1.29), P = 0.20
Fresh frozen plasma	2.9 (1.33-6.39), P = 0.007	3.07 (1.46-6.44), P = 0.003
Platelets	0.94 (0.43-2.06), P = 0.88	0.93 (0.44-1.96), P = 0.86
Liver-specific scores¹
CTP	1.35 (1.17-1.56), P < 0.001	1.35 (1.18-1.55), P < 0.001
MELD	1.10 (1.06-1.15), P < 0.001	1.11 (1.07-1.15), P < 0.001
MELD-Na	1.10 (1.06-1.15), P < 0.001	1.11 (1.07-1.15), P < 0.001
CLIF-SOFA	1.51 (1.29-1.76), P < 0.001	1.49 (1.27-1.73), P < 0.001
CLIF-C AD or ACLF	1.04 (1.01-1.07), P = 0.007	1.03 (1.004-1.06), P = 0.02
ACLF²	1.13 (1.60-3.0), P < 0.001	1.19 (1.09-1.39), P < 0.001

¹Hazard ratio per unit.

²Hazard ratio per grade.

CI: Confidence interval; 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; 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.

Citation: Terres AZ, Balbinot RS, Muscope ALF, Longen ML, Schena B, Cini BT, Rost Jr GL, Balensiefer JIL, Eberhardt LZ, Balbinot RA, Balbinot SS, Soldera J. Acute-on-chronic liver failure is independently associated with higher mortality for cirrhotic patients with acute esophageal variceal hemorrhage: Retrospective cohort study. World J Clin Cases 2023; 11(17): 4003-4018
URL: https://www.wjgnet.com/2307-8960/full/v11/i17/4003.htm
DOI: https://dx.doi.org/10.12998/wjcc.v11.i17.4003