SUMMARY BackgroundHepatic venous pressure gradient (HVPG) is a prognostic marker in patients with cirrhosis. Transient elastography measures liver stiffness (LS).

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Acute-on-chronic liver failure (ACLF) AVB + ACLF High rebleeding rate (25.2%) in 42 days High mortality rate (51.0%) in 42 days Pre-emptive TIPS in AVB + ACLF Low rebleeding rate (4.5%) in 42 days Low mortality rate (13.6%) in 42 days Pre-emptive TIPS Acute Variceal Bleeding (AVB) Highlights Variceal bleeding is frequently associated with ACLF in cirrhosis. ACLF is independently associated with rebleeding and mortality. Patients with variceal bleeding and ACLF can benefit from a preemptive (early) TIPS.