Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2023; 11(17): 4003-4018
Published online Jun 16, 2023. doi: 10.12998/wjcc.v11.i17.4003
Acute-on-chronic liver failure is independently associated with higher mortality for cirrhotic patients with acute esophageal variceal hemorrhage: Retrospective cohort study
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
Alana Zulian Terres, Raul Angelo Balbinot, Silvana Sartori Balbinot, Clinical Gastroenterology, Universidade de Caxias do Sul, Caxias do Sul 95020-002, Brazil
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, School of Medicine, Universidade de Caxias do Sul, Caxias do Sul 95020-002, Brazil
Jonathan Soldera, Department of Gastroenterology, University of South Wales, Cardiff CF37 1DL, United Kingdom
Author contributions: Terres AZ contributed to the design, data collection, writing, and review of the manuscript. Balbinot RS, Muscope ALF, Longen ML, Schena B, Cini BT, Rost Jr GL, Balensiefer JIL, and Eberhardt LZ all contributed to the data collection, writing, and review of the manuscript; Balbinot RA and Balbinot SS contributed to the design, writing, and review of the manuscript; Soldera J contributed to the design, statistical analysis, translation, writing, and review of the manuscript; all authors have read and approve the final manuscript.
Institutional review board statement: 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. This was done in conformity to the ethical guidelines of the 1975 Declaration of Helsinki.
Informed consent statement: As this study analyzed solely medical records, the need for an informed consent was waived by this human research ethics committee.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jonathan Soldera, MD, MSc, Tutor, Acute Medicine and Gastroenterology, University of South Wales, University of South Wales, 8 Forest Grove, Treforest, Pontypridd, Cardiff CF37 1DL, United Kingdom. jonathansoldera@gmail.com
Received: March 22, 2023
Peer-review started: March 22, 2023
First decision: April 11, 2023
Revised: April 15, 2023
Accepted: May 12, 2023
Article in press: May 12, 2023
Published online: June 16, 2023
Processing time: 82 Days and 6.2 Hours
Abstract
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.

Keywords: Gastrointestinal hemorrhage; Prognosis; Esophageal and gastric varices; Liver cirrhosis; Acute-on-chronic liver failure; Organ dysfunction scores

Core Tip: Acute esophageal variceal hemorrhage (AEVH) is a common complication of cirrhosis and might precipitate multi-organ failure, causing acute-on-chronic liver failure (ACLF). The purpose of this study is 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. This is a retrospective cohort study executed in Hospital Geral de Caxias do Sul, which gathered 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. 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. In conclusion, the 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.