Gastrointestinal hemorrhage as an acute-on-chronic liver failure trigger in cirrhotic patients

Abstract

Background. Acute-on-chronic liver failure (ACLF) is a syndrome characterized by acute decompensation of chronic liver disease associated with organ failures and very high short-term mortality. Objectives.To assess the incidence and factors predisposing to ACLF in patients with liver cirrhosis hospitalized due to acute gastrointestinal bleeding (GIB). Materials and methods.We collected and retrospectively analyzed the data of 89 consecutive patients (59 males (66.2%), median age 53 years (range: 44-62 years), mean Model for End-Stage Liver Disease (MELD) score 14.42 ±6.5, median Child-Turcotte-Pugh score 10 (range: 8-11), and acute GIB (72 variceal bleeding and 17 non-variceal bleeding cases). Acute-on-chronic liver failure was diagnosed based on European Association for the Study of the Liver -Chronic Liver Failure Consortium definition.Results. Twenty-seven (30.33%) patients met the criteria of ACLF during hospitalization: 8 (30%) had ACLF grade 1, 13 (48%) had ACLF grade 2 and 6 (22%) had ACLF grade 3. The most frequent organ failures were respiratory (22 (25%)), kidney (18 (20.23%)) and brain (17 (19. 1%)) failure. The MELD score value, creatinine level and presence of hepatic encephalopathy (HE) on admission were significant predictors of ACLF in the multivariate logistic regression model with optimal cutoff point for MELD score of 18.313 and optimal cutoff point for creatinine level of 1.35 mg/dL. Conclusions.In-hospital risk of ACLF in cirrhotic patients hospitalized for acute gastrointestinal hemorrhage is high despite successful arrest of bleeding. Elevated creatinine level, MELD score and the presence of HE on admission are the best predictors of ACLF during hospitalization in such patients.

To TIPS or Not to TIPS in High Risk of Variceal Rebleeding and Acute-on-Chronic Liver Failure

“…In a previous study, ACLF was diagnosed at admission in almost 20% of patients with portal hypertension bleeding. 16 In studies of patients with decompensated cirrhosis of predominantly alcoholic or hepatitis C virus (HCV) etiologies, the proportion ranged from 8.6 to 49.4%, [17][18][19][20][21][22][23][24] and from 7.3 to 35.7% in HBV-related cirrhosis (►Table 1). 17, [25][26][27][28] In all of To TIPS or Not to TIPS in High Risk of Variceal Rebleeding and ACLF Gu et al 193 these studies, due to their retrospective nature, GIB occurred concomitant with ACLF and not as a definite precipitant.…”

“…31,32 However, acute variceal bleeding (AVB) has been described in many studies as a well-known trigger of ACLF. 11,12,18,33 and severe GIB has been proven to have a significant impact on ACLF development 34,35 (►Table 1).…”