Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 2.1 (5-Year IF – 2.0)
Journal Citation Indicator (JCI) (2023) – 0.4
Scopus CiteScore – 3.7 (CiteScore Tracker – 4.3)
Index Copernicus  – 171.00; MNiSW – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2022, vol. 31, nr 8, August, p. 863–871

doi: 10.17219/acem/147464

Publication type: original article

Language: English

License: Creative Commons Attribution 3.0 Unported (CC BY 3.0)

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Cite as:


Rogalski P, Zaborowska M, Mazur M, et al. Gastrointestinal hemorrhage as an acute-on-chronic liver failure trigger in cirrhotic patients. Adv Clin Exp Med. 2022;31(8):863–871. doi:10.17219/acem/147464

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

Paweł Rogalski1,A,B,C,D,F, Marta Zaborowska1,B,C,D,E,F, Maria Mazur1,B,C,D,E,F, Żaneta Jankowska1,B,C,E,F, Alicja Piszczyk1,B,C,E,F, Edyta Mermer1,B,C,E,F, Andrzej Dąbrowski1,C,E,F, Jarosław Daniluk1,C,E,F

1 Department of Gastroenterology and Internal Medicine, Medical University of Bialystok, Poland

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.

Key words

liver cirrhosis, gastrointestinal bleeding, organ failure, gastrointestinal hemorrhage, acute-on-chronic liver failure

References (22)

  1. Jalan R, Gines P, Olson JC, et al. Acute-on chronic liver failure. J Hepatol. 2012;57(6):1336–1348. doi:10.1016/j.jhep.2012.06.026
  2. Hernaez R, Kramer JR, Liu Y, et al. Prevalence and short-term mortality of acute-on-chronic liver failure: A national cohort study from the USA. J Hepatol. 2019;70(4):639–647. doi:10.1016/j.jhep.2018.12.018
  3. Moreau R, Jalan R, Gines P, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology. 2013;144(7):1426–1437.e9. doi:10.1053/j.gastro.2013.02.042
  4. Zaccherini G, Weiss E, Moreau R. Acute-on-chronic liver failure: Definitions, pathophysiology and principles of treatment. JHEP Rep. 2021;3(1):100176. doi:10.1016/j.jhepr.2020.100176
  5. Trebicka J, Fernandez J, Papp M, et al. The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology. J Hepatol. 2020;73(4):842–854. doi:10.1016/j.jhep.2020.06.013
  6. Trebicka J, Fernandez J, Papp M, et al. PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis. J Hepatol. 2021;74(5):1097–1108. doi:10.1016/j.jhep.\2020.11.019
  7. Arroyo V, Moreau R, Jalan R. Acute-on-chronic liver failure. N Engl J Med. 2020;382(22):2137–2145. doi:10.1056/NEJMra1914900
  8. Clària J, Stauber RE, Coenraad MJ, et al. Systemic inflammation in decompensated cirrhosis: Characterization and role in acute-on-chronic liver failure. Hepatology. 2016;64(4):1249–1264. doi:10.1002/hep.28740
  9. Trebicka J, Amoros A, Pitarch C, et al. Addressing profiles of systemic inflammation across the different clinical phenotypes of acutely decompensated cirrhosis. Front Immunol. 2019;10:476. doi:10.3389/fimmu.2019.00476
  10. Jalan R, D’Amico G, Trebicka J, Moreau R, Angeli P, Arroyo V. New clinical and pathophysiological perspectives defining the trajectory of cirrhosis. J Hepatol. 2021;75:S14–S26. doi:10.1016/j.jhep.2021.01.018
  11. Heimbach JK, Kulik LM, Finn RS, et al. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology. 2018;67(1):358–380. doi:10.1002/hep.29086
  12. Mallet M, Rudler M, Thabut D. Variceal bleeding in cirrhotic patients. Gastroenterol Rep (Oxf). 2017;5(3):185–192. doi:10.1093/gastro/gox024
  13. de Franchis R. Expanding consensus in portal hypertension. J Hepatol. 2015;63(3):743–752. doi:10.1016/j.jhep.2015.05.022
  14. Rogalski P, Rogalska-Płońska M, Wróblewski E, et al. Laboratory evidence for hypercoagulability in cirrhotic patients with history of variceal bleeding. Thromb Res. 2019;178:41–46. doi:10.1016/j.thromres.2019.03.021
  15. Rogalski P, Rogalska-Płońska M, Wróblewski E, et al. Blood platelet function abnormalities in cirrhotic patients with esophageal varices in relation to the variceal bleeding history. Scand J Gastroenterol. 2019;54(3):311–318. doi:10.1080/00365521.2019.1578822
  16. Chavez-Tapia NC, Barrientos-Gutierrez T, Tellez-Avila F, et al. Meta-analysis: Antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding. An updated Cochrane review. Aliment Pharmacol Ther. 2011;34(5):509–518. doi:10.1111/j.1365-2036.2011.04746.x
  17. Trebicka J, Gu W, Ibáñez-Samaniego L, et al. Rebleeding and mortality risk are increased by ACLF but reduced by pre-emptive TIPS. J Hepatol. 2020;73(5):1082–1091. doi:10.1016/j.jhep.2020.04.024
  18. Kumar R, Kerbert AJC, Sheikh MF, et al. Determinants of mortality in patients with cirrhosis and uncontrolled variceal bleeding. J Hepatol. 2021;74(1):66–79. doi:10.1016/j.jhep.2020.06.010
  19. Lv Y, Wang Z, Li K, et al. Risk stratification based on Chronic Liver Failure Consortium Acute Decompensation Score in patients with Child–Pugh B cirrhosis and acute variceal bleeding. Hepatology. 2021;73(4):1478–1493. doi:10.1002/hep.31478
  20. Erasmus HP, Bektas R, Orland K, et al. Variceal bleeding has increased mortality compared to nonvariceal bleeding only in males. Eur J Gastroenterol Hepatol. 2021;33(1S):e94–e101. doi:10.1097/MEG.0000000000001964
  21. Ardevol A, Ibañez-Sanz G, Profitos J, et al. Survival of patients with cirrhosis and acute peptic ulcer bleeding compared with variceal bleeding using current first-line therapies. Hepatology. 2018;67(4):1458–1471. doi:10.1002/hep.29370
  22. Tandon P, Bishay K, Fisher S, et al. Comparison of clinical outcomes between variceal and non-variceal gastrointestinal bleeding in patients with cirrhosis: Outcomes of UGIB in cirrhosis. J Gastroenterol Hepatol. 2018;33(10):1773–1779. doi:10.1111/jgh.14147
© Wroclaw Medical University