Distinct course of portal hypertension in patients with cirrhosis with gastric variceal bleeding as their first decompensation: a propensity score-matched study

Agarwal, Samagra; Madhu, Deepak; Rana, Randeep; Gupta, Anany; Gopi, Srikanth; Gunjan, Deepak; Sharma, Sanchit

doi:10.1007/s12072-022-10451-3

Cited by 2 publications

(3 citation statements)

References 8 publications

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“…60,61 In ACLF patients, due to severe portal hypertension, circulatory dysfunction, coagulation and hemodynamic instability, those who develop variceal bleeding are facing a worse outcome (Figure 1 and Table 1). 50,54,59,62 With management of different complications or organ supportive treatment, patients with ACLF could become more severely ill (20.1%) (from a lower grade of ACLF to a higher grade), stay stable (30.4%) (no change of ACLF grade), improve (from a higher grade to a lower grade of ACLF) (7.0%) or even recover (42.5%) (from ACLF to non-ACLF). The 90-day mortality rate of patients with initial but eventually resolved ACLF could be decreased to below 20%.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…When patients with or without previous bleeding develop ACLF, they—compared with patients without ACLF—are more prone to present severe hemodynamic derangements, including onset of bleeding or a rebleeding episode, which may promote the progression of ACLF and subsequently result in death. 48 More importantly, almost all studies that investigated patients with decompensated cirrhosis found that, especially in patients with ACLF, those with GIB have a 10 to 50% higher risk of death within 90 days than patients without GIB, 22 25 31 49 50 51 52 53 54 55 and that the odds ratio of GIB as an independent risk factor for mortality ranges from 1.8 to 4.8. 8 21 27 56 57 58 ( Table 1 ).…”

Section: Bleeding As Complication Of Aclfmentioning

confidence: 99%

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

Kimmann

Laleman

et al. 2023

Semin Liver Dis

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Variceal bleeding is a consequence of severe portal hypertension in patients with liver cirrhosis. Although the rate of bleeding has decreased over time, variceal bleeding in the presence of acute-on-chronic liver failure (ACLF) carries a high-risk of treatment failure and short-term mortality. Treatment and/or removal of precipitating events (mainly bacterial infection and alcoholic hepatitis) and decrease of portal pressure may improve outcome of patients with acute decompensation or ACLF. Transjugular intrahepatic systemic shunts (TIPS), especially in the pre-emptive situation, have been found to efficiently control bleeding, prevent rebleeding and reduce short-term mortality. Therefore, TIPS placement should be considered as an option in the management of ACLF patients with variceal bleeding.

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Section: Accepted Manuscriptmentioning

confidence: 99%

Section: Bleeding As Complication Of Aclfmentioning

confidence: 99%

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

Kimmann

Laleman

et al. 2023

Semin Liver Dis

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“…In addition, there was a good correlation between liver stifness measurements and portal hypertension [5,6]. Furthermore, portal hypertension is a consequence of cirrhosis and is an important determinant of the course and prognosis of esophageal varices [7,8]. However, there are still gaps in the use of noninvasive means to predict patients with hepatitis B cirrhosis experiencing recurrent bleeding.…”

Section: Introductionmentioning

confidence: 99%

A Practical Model for Predicting Esophageal Variceal Rebleeding in Patients with Hepatitis B-Associated Cirrhosis

Liu

Nie

Liu

et al. 2023

International Journal of Clinical Practice

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Background. Variceal rebleeding is a significant and potentially life-threatening complication of cirrhosis. Unfortunately, currently, there is no reliable method for stratifying high-risk patients. Liver stiffness measurements (LSM) have been shown to have a predictive value in identifying complications associated with portal hypertension, including first-time bleeding. However, there is a lack of evidence to confirm that LSM is reliable in predicting variceal rebleeding. The objective of our study was to evaluate the ability of generating a extreme gradient boosting (XGBoost) algorithm model to improve the prediction of variceal rebleeding. Methods. This retrospective analysis examined a cohort of 284 patients with hepatitis B-related cirrhosis. XGBoost models were developed using laboratory data, LSM, and imaging data to predict the risk of rebleeding in the patients. In addition, we compared the XGBoost models with traditional logistic regression (LR) models. We evaluated and compared the two models using the area under the receiver operating characteristic curve (AUROC) and other model performance parameters. Lastly, we validated the models using nomograms and decision curve analysis (DCA). Results. During a median follow-up of 66.6 weeks, 72 patients experienced rebleeding, including 21 (7.39%) and 61 (21.48%) patients who rebleed within 6 weeks and 1 year, respectively. In brief, the AUC of the LR models in predicting rebleeding at 6 weeks and 1 year was 0.828 (0.759–0.897) and 0.799 (0.738–0.860), respectively. In contrast, the accuracy of the XGBoost model in predicting rebleeding at 6 weeks and 1 year was 0.985 (0.907–0.731) and 0.931 (0.806–0.935), respectively. LSM and high-density lipoprotein (HDL) levels differed significantly between the rebleeding and nonrebleeding groups, with LSM being a reliable predictor in those models. The XGBoost models outperformed the LR models in predicting rebleeding within 6 weeks and 1 year, as demonstrated by the ROC and DCA curves. Conclusion. The XGBoost algorithm model can achieve higher accuracy than the LR model in predicting rebleeding, making it a clinically beneficial tool. This implies that the XGBoost model is better suited for predicting the risk of esophageal variceal rebleeding in patients.

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Distinct course of portal hypertension in patients with cirrhosis with gastric variceal bleeding as their first decompensation: a propensity score-matched study

Cited by 2 publications

References 8 publications

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

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

A Practical Model for Predicting Esophageal Variceal Rebleeding in Patients with Hepatitis B-Associated Cirrhosis

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