Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 1.736
5-Year Impact Factor – 2.135
Index Copernicus  – 166.39
MEiN – 70 pts

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

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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)

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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

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