Rebleeding and mortality risk are increased by ACLF but reduced by pre-emptive TIPS

Abstract

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.

Acute-on-chronic liver failure: A predictor of poor prognosis in patients with variceal bleeding or a risk factor for variceal bleeding?

“…5 According to Joshi et al, 6 variceal bleeding was the most frequent morbidity accompanying ACLF among 30% of the patients in their cohort. Both studies by Shin et al 1 and Trebicka et al 2 did not reveal the temporal relationship between variceal bleeding and ACLF. Therefore, we could not compare the survival according to the order of the two pathologic conditions.…”

“…The overall survival of patients with ACLF was lower compared to those without ACLF, and a higher ACLF grade was related to lower overall survival. Recently, Trebicka et al 2 first reported that 17.8% of 2,138 patients with acute variceal bleeding had ACLF at admission, and that the presence of ACLF was independently related to rebleeding and mortality. Therefore, we assumed that 10-20% of cases involving acute variceal bleeding may experience ACLF at admission or dur-ing hospitalization, suggesting the need for careful evaluation of patients with variceal bleeding.…”

“…Several studies showed that patients with early or pre-emptive TIPS had a lower rebleeding risk and higher overall survival, even in ACLF patients. [2][3][4] However, the aggravation of liver failure in severe decompensated cirrhosis still remains a concern. Lv et al 4 reported that early TIPS with covered stents improved transplantation-free survival in selected patients with advanced cirrhosis (Child B or C) and acute variceal bleeding compared to standard treatments, such as endoscopic band ligation and beta-blockers following salvage TIPS as needed.…”

Acute-on-chronic liver failure

“…Two recently published studies show that the presence of ACLF is the single most important determinant of death in patients with variceal bleeding, and pre-emptive transjugular intrahepatic portosystemic shunt (TIPSS) as well as rescue TIPSS improves survival in patients with ACLF. 13,14…”

Gerinnungsmanagement in der gastroenterologischen Akut- und Intensivmedizin

“…Patienten mit Leberzirrhose können ein generell erhöhtes thromb(embolisches) Risiko im Vergleich zur Normalbevölkerung aufweisen [16], das situativ (Infekte, Nierenversagen), aber auch bei fortgeschrittenen Erkrankungsstadien (dekompensierte Leberzirrhose, Ösophagusvarizen) in ein erhöhtes Blutungsrisiko umschlagen kann [17,18].…”