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@Article{Rogalski2022-08-25,
author={Rogalski, Paweł
and Zaborowska, Marta
and Mazur, Maria
and Jankowska, Żaneta
and Piszczyk, Alicja
and Mermer, Edyta
and Dąbrowski, Andrzej
and Daniluk, Jarosław},
title={Gastrointestinal hemorrhage as an acute-on-chronic liver failure trigger in cirrhotic patients},
title={Gastrointestinal hemorrhage as an acute-on-chronic liver failure trigger in cirrhotic patients},
journal={Advances in Clinical and Experimental Medicine},
year={2022},
volume={31},
number={8},
pages={863--871},
month={08},
day={25},
publisher={Wroclaw Medical University},
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).Material 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.Conclusion. 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.},
issn={1899-5276},
doi={10.17219/acem/147464},
url={http://dx.doi.org/10.17219/acem/147464},