Rebleeding and mortality risk are increased by ACLF but reduced by pre-emptive TIPS
BACKGROUND & AIMS: The relationship between acute-on-chronic liver failure (ACLF) and acute variceal bleeding (AVB) is poorly understood. Specifically, the prevalence and prognosis of ACLF in the context of AVB is unclear, while the role of transjugular intrahepatic portosystemic shunt (TIPS) in...
Gespeichert in:
| Veröffentlicht in: | JOURNAL OF HEPATOLOGY 2020-11, Vol.73 (5), p.1082-1091 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 1091 |
|---|---|
| container_issue | 5 |
| container_start_page | 1082 |
| container_title | JOURNAL OF HEPATOLOGY |
| container_volume | 73 |
| creator | Trebicka, Jonel Gu, Wenyi Ibanez-Samaniego, Luis Hernandez-Gea, Virginia Pitarch, Carla Garcia, Elisabet Procopet, Bogdan Giraldez, Alvaro Amitrano, Lucio Villanueva, Candid Thabut, Dominique Silva-Junior, Gilberto Martinez, Javier Genesc, Joan Bureau, Cristophe Llop, Elba Laleman, Wim Palazon, Jose Maria Castellote, Jose Rodrigues, Susanag Gluud, Liselotte Ferreira, Carlos Noronha Barcelo, Rafael Canete, Nuria Rodriguez, Manuel Ferlitsch, Arnulf Mundi, Jose Luis Gronbaek, Henning Hernandez-Guerra, Manuel Sassatelli, Romano Dell'Era, Alessandra Senzolo, Marco Abraldes, Juan G Romero-Gomez, Manuel Zipprich, Alexander Casas, Meritxell Masnou, Helena Primignani, Massimo Weiss, Emmanuel Catalina, Maria-Vega Erasmus, Hans-Peter Uschner, Frank Erhard Schulz, Martin Brol, Maximilian J Praktiknjo, Michael Chang, Johannes Krag, Aleksander Nevens, Frederik Calleja, Jose Luis Robic, Marie Angele Conejo, Irene Albillos, Agustin Rudler, Marika Alvarado, Edilmar Guardascione, Maria Anna Tantau, Marcel Bosch, Jaime Torres, Ferran Pavesi, Marco Garcia-Pagan, Juan Carlos Jansen, Christian Banares, Rafael |
| description | BACKGROUND & AIMS: The relationship between acute-on-chronic liver failure (ACLF) and acute variceal bleeding (AVB) is poorly understood. Specifically, the prevalence and prognosis of ACLF in the context of AVB is unclear, while the role of transjugular intrahepatic portosystemic shunt (TIPS) in the management in patients with ACLF has not been described to date. METHODS: A multicenter, international, observational study was conducted in 2,138 patients from 34 centers between 2011 and 2015. ACLF was defined and graded according to the EASL-CLIF consortium definition. Placement of pre-emptive TIPS (pTIPS) was based on individual center policy. Patients were followed-up for 1 year, until death or liver transplantation. Cox regression and competing risk models (Gray's test) were used to identify independent predictors of rebleeding or mortality. RESULTS: At admission, 380/2,138 (17.8%) patients had ACLF according to EASL-CLIF criteria (grade 1: 38.7%; grade 2: 39.2%; grade 3: 22.1%). The 42-day rebleeding (19% vs. 10%; p |
| format | Article |
| fullrecord | <record><control><sourceid>kuleuven</sourceid><recordid>TN_cdi_kuleuven_dspace_123456789_654315</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>123456789_654315</sourcerecordid><originalsourceid>FETCH-kuleuven_dspace_123456789_6543153</originalsourceid><addsrcrecordid>eNqNjMsKgkAUQGdRkFn_cHctQhgdn8uQpKBFpHsZnVtMPpKZUfLvW9QHtDpwOJwFsagbxk7sRfGKrLV-UkoZTXyL5DesWkQh-wfwXkD3Uoa30sygpG6AKwTZ1wq5RgHVDIf0kkE1GlAoxvrrBoUOdoORE0JxvuYbsrzzVuP2R5vssmORnpxmbHGcsC-FHniNpesxPwijOCnDwGduwGyy_68szduw_78fveZM7Q</addsrcrecordid><sourcetype>Institutional Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Rebleeding and mortality risk are increased by ACLF but reduced by pre-emptive TIPS</title><source>Lirias (KU Leuven Association)</source><source>Access via ScienceDirect (Elsevier)</source><creator>Trebicka, Jonel ; Gu, Wenyi ; Ibanez-Samaniego, Luis ; Hernandez-Gea, Virginia ; Pitarch, Carla ; Garcia, Elisabet ; Procopet, Bogdan ; Giraldez, Alvaro ; Amitrano, Lucio ; Villanueva, Candid ; Thabut, Dominique ; Silva-Junior, Gilberto ; Martinez, Javier ; Genesc, Joan ; Bureau, Cristophe ; Llop, Elba ; Laleman, Wim ; Palazon, Jose Maria ; Castellote, Jose ; Rodrigues, Susanag ; Gluud, Liselotte ; Ferreira, Carlos Noronha ; Barcelo, Rafael ; Canete, Nuria ; Rodriguez, Manuel ; Ferlitsch, Arnulf ; Mundi, Jose Luis ; Gronbaek, Henning ; Hernandez-Guerra, Manuel ; Sassatelli, Romano ; Dell'Era, Alessandra ; Senzolo, Marco ; Abraldes, Juan G ; Romero-Gomez, Manuel ; Zipprich, Alexander ; Casas, Meritxell ; Masnou, Helena ; Primignani, Massimo ; Weiss, Emmanuel ; Catalina, Maria-Vega ; Erasmus, Hans-Peter ; Uschner, Frank Erhard ; Schulz, Martin ; Brol, Maximilian J ; Praktiknjo, Michael ; Chang, Johannes ; Krag, Aleksander ; Nevens, Frederik ; Calleja, Jose Luis ; Robic, Marie Angele ; Conejo, Irene ; Albillos, Agustin ; Rudler, Marika ; Alvarado, Edilmar ; Guardascione, Maria Anna ; Tantau, Marcel ; Bosch, Jaime ; Torres, Ferran ; Pavesi, Marco ; Garcia-Pagan, Juan Carlos ; Jansen, Christian ; Banares, Rafael</creator><creatorcontrib>Trebicka, Jonel ; Gu, Wenyi ; Ibanez-Samaniego, Luis ; Hernandez-Gea, Virginia ; Pitarch, Carla ; Garcia, Elisabet ; Procopet, Bogdan ; Giraldez, Alvaro ; Amitrano, Lucio ; Villanueva, Candid ; Thabut, Dominique ; Silva-Junior, Gilberto ; Martinez, Javier ; Genesc, Joan ; Bureau, Cristophe ; Llop, Elba ; Laleman, Wim ; Palazon, Jose Maria ; Castellote, Jose ; Rodrigues, Susanag ; Gluud, Liselotte ; Ferreira, Carlos Noronha ; Barcelo, Rafael ; Canete, Nuria ; Rodriguez, Manuel ; Ferlitsch, Arnulf ; Mundi, Jose Luis ; Gronbaek, Henning ; Hernandez-Guerra, Manuel ; Sassatelli, Romano ; Dell'Era, Alessandra ; Senzolo, Marco ; Abraldes, Juan G ; Romero-Gomez, Manuel ; Zipprich, Alexander ; Casas, Meritxell ; Masnou, Helena ; Primignani, Massimo ; Weiss, Emmanuel ; Catalina, Maria-Vega ; Erasmus, Hans-Peter ; Uschner, Frank Erhard ; Schulz, Martin ; Brol, Maximilian J ; Praktiknjo, Michael ; Chang, Johannes ; Krag, Aleksander ; Nevens, Frederik ; Calleja, Jose Luis ; Robic, Marie Angele ; Conejo, Irene ; Albillos, Agustin ; Rudler, Marika ; Alvarado, Edilmar ; Guardascione, Maria Anna ; Tantau, Marcel ; Bosch, Jaime ; Torres, Ferran ; Pavesi, Marco ; Garcia-Pagan, Juan Carlos ; Jansen, Christian ; Banares, Rafael</creatorcontrib><description>BACKGROUND & AIMS: The relationship between acute-on-chronic liver failure (ACLF) and acute variceal bleeding (AVB) is poorly understood. Specifically, the prevalence and prognosis of ACLF in the context of AVB is unclear, while the role of transjugular intrahepatic portosystemic shunt (TIPS) in the management in patients with ACLF has not been described to date. METHODS: A multicenter, international, observational study was conducted in 2,138 patients from 34 centers between 2011 and 2015. ACLF was defined and graded according to the EASL-CLIF consortium definition. Placement of pre-emptive TIPS (pTIPS) was based on individual center policy. Patients were followed-up for 1 year, until death or liver transplantation. Cox regression and competing risk models (Gray's test) were used to identify independent predictors of rebleeding or mortality. RESULTS: At admission, 380/2,138 (17.8%) patients had ACLF according to EASL-CLIF criteria (grade 1: 38.7%; grade 2: 39.2%; grade 3: 22.1%). The 42-day rebleeding (19% vs. 10%; p <0.001) and mortality (47% vs. 10%; p <0.001) rates were higher in patients with ACLF and increased with ACLF grades. Of note, the presence of ACLF was independently associated with rebleeding and mortality. pTIPS placement improved survival in patients with ACLF at 42 days and 1 year. This effect was also observed in propensity score matching analysis of 66 patients with ACLF, of whom 44 received pTIPs and 22 did not. CONCLUSIONS: This large multicenter international real-life study identified ACLF at admission as an independent predictor of rebleeding and mortality in patients with AVB. Moreover, pTIPS was associated with improved survival in patients with ACLF and AVB. LAY SUMMARY: Acute variceal bleeding is a deadly complication of liver cirrhosis that results from severe portal hypertension. This study demonstrates that the presence of acute-on-chronic liver failure (ACLF) is the strongest predictor of mortality in patients with acute variceal bleeding. Importantly, patients with ACLF and acute variceal (re)bleeding benefit from pre-emptive (early) placement of a transjugular intrahepatic portosystemic shunt.</description><identifier>ISSN: 0168-8278</identifier><language>eng</language><publisher>ELSEVIER</publisher><ispartof>JOURNAL OF HEPATOLOGY, 2020-11, Vol.73 (5), p.1082-1091</ispartof><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,315,780,784,27860</link.rule.ids></links><search><creatorcontrib>Trebicka, Jonel</creatorcontrib><creatorcontrib>Gu, Wenyi</creatorcontrib><creatorcontrib>Ibanez-Samaniego, Luis</creatorcontrib><creatorcontrib>Hernandez-Gea, Virginia</creatorcontrib><creatorcontrib>Pitarch, Carla</creatorcontrib><creatorcontrib>Garcia, Elisabet</creatorcontrib><creatorcontrib>Procopet, Bogdan</creatorcontrib><creatorcontrib>Giraldez, Alvaro</creatorcontrib><creatorcontrib>Amitrano, Lucio</creatorcontrib><creatorcontrib>Villanueva, Candid</creatorcontrib><creatorcontrib>Thabut, Dominique</creatorcontrib><creatorcontrib>Silva-Junior, Gilberto</creatorcontrib><creatorcontrib>Martinez, Javier</creatorcontrib><creatorcontrib>Genesc, Joan</creatorcontrib><creatorcontrib>Bureau, Cristophe</creatorcontrib><creatorcontrib>Llop, Elba</creatorcontrib><creatorcontrib>Laleman, Wim</creatorcontrib><creatorcontrib>Palazon, Jose Maria</creatorcontrib><creatorcontrib>Castellote, Jose</creatorcontrib><creatorcontrib>Rodrigues, Susanag</creatorcontrib><creatorcontrib>Gluud, Liselotte</creatorcontrib><creatorcontrib>Ferreira, Carlos Noronha</creatorcontrib><creatorcontrib>Barcelo, Rafael</creatorcontrib><creatorcontrib>Canete, Nuria</creatorcontrib><creatorcontrib>Rodriguez, Manuel</creatorcontrib><creatorcontrib>Ferlitsch, Arnulf</creatorcontrib><creatorcontrib>Mundi, Jose Luis</creatorcontrib><creatorcontrib>Gronbaek, Henning</creatorcontrib><creatorcontrib>Hernandez-Guerra, Manuel</creatorcontrib><creatorcontrib>Sassatelli, Romano</creatorcontrib><creatorcontrib>Dell'Era, Alessandra</creatorcontrib><creatorcontrib>Senzolo, Marco</creatorcontrib><creatorcontrib>Abraldes, Juan G</creatorcontrib><creatorcontrib>Romero-Gomez, Manuel</creatorcontrib><creatorcontrib>Zipprich, Alexander</creatorcontrib><creatorcontrib>Casas, Meritxell</creatorcontrib><creatorcontrib>Masnou, Helena</creatorcontrib><creatorcontrib>Primignani, Massimo</creatorcontrib><creatorcontrib>Weiss, Emmanuel</creatorcontrib><creatorcontrib>Catalina, Maria-Vega</creatorcontrib><creatorcontrib>Erasmus, Hans-Peter</creatorcontrib><creatorcontrib>Uschner, Frank Erhard</creatorcontrib><creatorcontrib>Schulz, Martin</creatorcontrib><creatorcontrib>Brol, Maximilian J</creatorcontrib><creatorcontrib>Praktiknjo, Michael</creatorcontrib><creatorcontrib>Chang, Johannes</creatorcontrib><creatorcontrib>Krag, Aleksander</creatorcontrib><creatorcontrib>Nevens, Frederik</creatorcontrib><creatorcontrib>Calleja, Jose Luis</creatorcontrib><creatorcontrib>Robic, Marie Angele</creatorcontrib><creatorcontrib>Conejo, Irene</creatorcontrib><creatorcontrib>Albillos, Agustin</creatorcontrib><creatorcontrib>Rudler, Marika</creatorcontrib><creatorcontrib>Alvarado, Edilmar</creatorcontrib><creatorcontrib>Guardascione, Maria Anna</creatorcontrib><creatorcontrib>Tantau, Marcel</creatorcontrib><creatorcontrib>Bosch, Jaime</creatorcontrib><creatorcontrib>Torres, Ferran</creatorcontrib><creatorcontrib>Pavesi, Marco</creatorcontrib><creatorcontrib>Garcia-Pagan, Juan Carlos</creatorcontrib><creatorcontrib>Jansen, Christian</creatorcontrib><creatorcontrib>Banares, Rafael</creatorcontrib><title>Rebleeding and mortality risk are increased by ACLF but reduced by pre-emptive TIPS</title><title>JOURNAL OF HEPATOLOGY</title><description>BACKGROUND & AIMS: The relationship between acute-on-chronic liver failure (ACLF) and acute variceal bleeding (AVB) is poorly understood. Specifically, the prevalence and prognosis of ACLF in the context of AVB is unclear, while the role of transjugular intrahepatic portosystemic shunt (TIPS) in the management in patients with ACLF has not been described to date. METHODS: A multicenter, international, observational study was conducted in 2,138 patients from 34 centers between 2011 and 2015. ACLF was defined and graded according to the EASL-CLIF consortium definition. Placement of pre-emptive TIPS (pTIPS) was based on individual center policy. Patients were followed-up for 1 year, until death or liver transplantation. Cox regression and competing risk models (Gray's test) were used to identify independent predictors of rebleeding or mortality. RESULTS: At admission, 380/2,138 (17.8%) patients had ACLF according to EASL-CLIF criteria (grade 1: 38.7%; grade 2: 39.2%; grade 3: 22.1%). The 42-day rebleeding (19% vs. 10%; p <0.001) and mortality (47% vs. 10%; p <0.001) rates were higher in patients with ACLF and increased with ACLF grades. Of note, the presence of ACLF was independently associated with rebleeding and mortality. pTIPS placement improved survival in patients with ACLF at 42 days and 1 year. This effect was also observed in propensity score matching analysis of 66 patients with ACLF, of whom 44 received pTIPs and 22 did not. CONCLUSIONS: This large multicenter international real-life study identified ACLF at admission as an independent predictor of rebleeding and mortality in patients with AVB. Moreover, pTIPS was associated with improved survival in patients with ACLF and AVB. LAY SUMMARY: Acute variceal bleeding is a deadly complication of liver cirrhosis that results from severe portal hypertension. This study demonstrates that the presence of acute-on-chronic liver failure (ACLF) is the strongest predictor of mortality in patients with acute variceal bleeding. Importantly, patients with ACLF and acute variceal (re)bleeding benefit from pre-emptive (early) placement of a transjugular intrahepatic portosystemic shunt.</description><issn>0168-8278</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>FZOIL</sourceid><recordid>eNqNjMsKgkAUQGdRkFn_cHctQhgdn8uQpKBFpHsZnVtMPpKZUfLvW9QHtDpwOJwFsagbxk7sRfGKrLV-UkoZTXyL5DesWkQh-wfwXkD3Uoa30sygpG6AKwTZ1wq5RgHVDIf0kkE1GlAoxvrrBoUOdoORE0JxvuYbsrzzVuP2R5vssmORnpxmbHGcsC-FHniNpesxPwijOCnDwGduwGyy_68szduw_78fveZM7Q</recordid><startdate>202011</startdate><enddate>202011</enddate><creator>Trebicka, Jonel</creator><creator>Gu, Wenyi</creator><creator>Ibanez-Samaniego, Luis</creator><creator>Hernandez-Gea, Virginia</creator><creator>Pitarch, Carla</creator><creator>Garcia, Elisabet</creator><creator>Procopet, Bogdan</creator><creator>Giraldez, Alvaro</creator><creator>Amitrano, Lucio</creator><creator>Villanueva, Candid</creator><creator>Thabut, Dominique</creator><creator>Silva-Junior, Gilberto</creator><creator>Martinez, Javier</creator><creator>Genesc, Joan</creator><creator>Bureau, Cristophe</creator><creator>Llop, Elba</creator><creator>Laleman, Wim</creator><creator>Palazon, Jose Maria</creator><creator>Castellote, Jose</creator><creator>Rodrigues, Susanag</creator><creator>Gluud, Liselotte</creator><creator>Ferreira, Carlos Noronha</creator><creator>Barcelo, Rafael</creator><creator>Canete, Nuria</creator><creator>Rodriguez, Manuel</creator><creator>Ferlitsch, Arnulf</creator><creator>Mundi, Jose Luis</creator><creator>Gronbaek, Henning</creator><creator>Hernandez-Guerra, Manuel</creator><creator>Sassatelli, Romano</creator><creator>Dell'Era, Alessandra</creator><creator>Senzolo, Marco</creator><creator>Abraldes, Juan G</creator><creator>Romero-Gomez, Manuel</creator><creator>Zipprich, Alexander</creator><creator>Casas, Meritxell</creator><creator>Masnou, Helena</creator><creator>Primignani, Massimo</creator><creator>Weiss, Emmanuel</creator><creator>Catalina, Maria-Vega</creator><creator>Erasmus, Hans-Peter</creator><creator>Uschner, Frank Erhard</creator><creator>Schulz, Martin</creator><creator>Brol, Maximilian J</creator><creator>Praktiknjo, Michael</creator><creator>Chang, Johannes</creator><creator>Krag, Aleksander</creator><creator>Nevens, Frederik</creator><creator>Calleja, Jose Luis</creator><creator>Robic, Marie Angele</creator><creator>Conejo, Irene</creator><creator>Albillos, Agustin</creator><creator>Rudler, Marika</creator><creator>Alvarado, Edilmar</creator><creator>Guardascione, Maria Anna</creator><creator>Tantau, Marcel</creator><creator>Bosch, Jaime</creator><creator>Torres, Ferran</creator><creator>Pavesi, Marco</creator><creator>Garcia-Pagan, Juan Carlos</creator><creator>Jansen, Christian</creator><creator>Banares, Rafael</creator><general>ELSEVIER</general><scope>FZOIL</scope></search><sort><creationdate>202011</creationdate><title>Rebleeding and mortality risk are increased by ACLF but reduced by pre-emptive TIPS</title><author>Trebicka, Jonel ; Gu, Wenyi ; Ibanez-Samaniego, Luis ; Hernandez-Gea, Virginia ; Pitarch, Carla ; Garcia, Elisabet ; Procopet, Bogdan ; Giraldez, Alvaro ; Amitrano, Lucio ; Villanueva, Candid ; Thabut, Dominique ; Silva-Junior, Gilberto ; Martinez, Javier ; Genesc, Joan ; Bureau, Cristophe ; Llop, Elba ; Laleman, Wim ; Palazon, Jose Maria ; Castellote, Jose ; Rodrigues, Susanag ; Gluud, Liselotte ; Ferreira, Carlos Noronha ; Barcelo, Rafael ; Canete, Nuria ; Rodriguez, Manuel ; Ferlitsch, Arnulf ; Mundi, Jose Luis ; Gronbaek, Henning ; Hernandez-Guerra, Manuel ; Sassatelli, Romano ; Dell'Era, Alessandra ; Senzolo, Marco ; Abraldes, Juan G ; Romero-Gomez, Manuel ; Zipprich, Alexander ; Casas, Meritxell ; Masnou, Helena ; Primignani, Massimo ; Weiss, Emmanuel ; Catalina, Maria-Vega ; Erasmus, Hans-Peter ; Uschner, Frank Erhard ; Schulz, Martin ; Brol, Maximilian J ; Praktiknjo, Michael ; Chang, Johannes ; Krag, Aleksander ; Nevens, Frederik ; Calleja, Jose Luis ; Robic, Marie Angele ; Conejo, Irene ; Albillos, Agustin ; Rudler, Marika ; Alvarado, Edilmar ; Guardascione, Maria Anna ; Tantau, Marcel ; Bosch, Jaime ; Torres, Ferran ; Pavesi, Marco ; Garcia-Pagan, Juan Carlos ; Jansen, Christian ; Banares, Rafael</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-kuleuven_dspace_123456789_6543153</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Trebicka, Jonel</creatorcontrib><creatorcontrib>Gu, Wenyi</creatorcontrib><creatorcontrib>Ibanez-Samaniego, Luis</creatorcontrib><creatorcontrib>Hernandez-Gea, Virginia</creatorcontrib><creatorcontrib>Pitarch, Carla</creatorcontrib><creatorcontrib>Garcia, Elisabet</creatorcontrib><creatorcontrib>Procopet, Bogdan</creatorcontrib><creatorcontrib>Giraldez, Alvaro</creatorcontrib><creatorcontrib>Amitrano, Lucio</creatorcontrib><creatorcontrib>Villanueva, Candid</creatorcontrib><creatorcontrib>Thabut, Dominique</creatorcontrib><creatorcontrib>Silva-Junior, Gilberto</creatorcontrib><creatorcontrib>Martinez, Javier</creatorcontrib><creatorcontrib>Genesc, Joan</creatorcontrib><creatorcontrib>Bureau, Cristophe</creatorcontrib><creatorcontrib>Llop, Elba</creatorcontrib><creatorcontrib>Laleman, Wim</creatorcontrib><creatorcontrib>Palazon, Jose Maria</creatorcontrib><creatorcontrib>Castellote, Jose</creatorcontrib><creatorcontrib>Rodrigues, Susanag</creatorcontrib><creatorcontrib>Gluud, Liselotte</creatorcontrib><creatorcontrib>Ferreira, Carlos Noronha</creatorcontrib><creatorcontrib>Barcelo, Rafael</creatorcontrib><creatorcontrib>Canete, Nuria</creatorcontrib><creatorcontrib>Rodriguez, Manuel</creatorcontrib><creatorcontrib>Ferlitsch, Arnulf</creatorcontrib><creatorcontrib>Mundi, Jose Luis</creatorcontrib><creatorcontrib>Gronbaek, Henning</creatorcontrib><creatorcontrib>Hernandez-Guerra, Manuel</creatorcontrib><creatorcontrib>Sassatelli, Romano</creatorcontrib><creatorcontrib>Dell'Era, Alessandra</creatorcontrib><creatorcontrib>Senzolo, Marco</creatorcontrib><creatorcontrib>Abraldes, Juan G</creatorcontrib><creatorcontrib>Romero-Gomez, Manuel</creatorcontrib><creatorcontrib>Zipprich, Alexander</creatorcontrib><creatorcontrib>Casas, Meritxell</creatorcontrib><creatorcontrib>Masnou, Helena</creatorcontrib><creatorcontrib>Primignani, Massimo</creatorcontrib><creatorcontrib>Weiss, Emmanuel</creatorcontrib><creatorcontrib>Catalina, Maria-Vega</creatorcontrib><creatorcontrib>Erasmus, Hans-Peter</creatorcontrib><creatorcontrib>Uschner, Frank Erhard</creatorcontrib><creatorcontrib>Schulz, Martin</creatorcontrib><creatorcontrib>Brol, Maximilian J</creatorcontrib><creatorcontrib>Praktiknjo, Michael</creatorcontrib><creatorcontrib>Chang, Johannes</creatorcontrib><creatorcontrib>Krag, Aleksander</creatorcontrib><creatorcontrib>Nevens, Frederik</creatorcontrib><creatorcontrib>Calleja, Jose Luis</creatorcontrib><creatorcontrib>Robic, Marie Angele</creatorcontrib><creatorcontrib>Conejo, Irene</creatorcontrib><creatorcontrib>Albillos, Agustin</creatorcontrib><creatorcontrib>Rudler, Marika</creatorcontrib><creatorcontrib>Alvarado, Edilmar</creatorcontrib><creatorcontrib>Guardascione, Maria Anna</creatorcontrib><creatorcontrib>Tantau, Marcel</creatorcontrib><creatorcontrib>Bosch, Jaime</creatorcontrib><creatorcontrib>Torres, Ferran</creatorcontrib><creatorcontrib>Pavesi, Marco</creatorcontrib><creatorcontrib>Garcia-Pagan, Juan Carlos</creatorcontrib><creatorcontrib>Jansen, Christian</creatorcontrib><creatorcontrib>Banares, Rafael</creatorcontrib><collection>Lirias (KU Leuven Association)</collection><jtitle>JOURNAL OF HEPATOLOGY</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Trebicka, Jonel</au><au>Gu, Wenyi</au><au>Ibanez-Samaniego, Luis</au><au>Hernandez-Gea, Virginia</au><au>Pitarch, Carla</au><au>Garcia, Elisabet</au><au>Procopet, Bogdan</au><au>Giraldez, Alvaro</au><au>Amitrano, Lucio</au><au>Villanueva, Candid</au><au>Thabut, Dominique</au><au>Silva-Junior, Gilberto</au><au>Martinez, Javier</au><au>Genesc, Joan</au><au>Bureau, Cristophe</au><au>Llop, Elba</au><au>Laleman, Wim</au><au>Palazon, Jose Maria</au><au>Castellote, Jose</au><au>Rodrigues, Susanag</au><au>Gluud, Liselotte</au><au>Ferreira, Carlos Noronha</au><au>Barcelo, Rafael</au><au>Canete, Nuria</au><au>Rodriguez, Manuel</au><au>Ferlitsch, Arnulf</au><au>Mundi, Jose Luis</au><au>Gronbaek, Henning</au><au>Hernandez-Guerra, Manuel</au><au>Sassatelli, Romano</au><au>Dell'Era, Alessandra</au><au>Senzolo, Marco</au><au>Abraldes, Juan G</au><au>Romero-Gomez, Manuel</au><au>Zipprich, Alexander</au><au>Casas, Meritxell</au><au>Masnou, Helena</au><au>Primignani, Massimo</au><au>Weiss, Emmanuel</au><au>Catalina, Maria-Vega</au><au>Erasmus, Hans-Peter</au><au>Uschner, Frank Erhard</au><au>Schulz, Martin</au><au>Brol, Maximilian J</au><au>Praktiknjo, Michael</au><au>Chang, Johannes</au><au>Krag, Aleksander</au><au>Nevens, Frederik</au><au>Calleja, Jose Luis</au><au>Robic, Marie Angele</au><au>Conejo, Irene</au><au>Albillos, Agustin</au><au>Rudler, Marika</au><au>Alvarado, Edilmar</au><au>Guardascione, Maria Anna</au><au>Tantau, Marcel</au><au>Bosch, Jaime</au><au>Torres, Ferran</au><au>Pavesi, Marco</au><au>Garcia-Pagan, Juan Carlos</au><au>Jansen, Christian</au><au>Banares, Rafael</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Rebleeding and mortality risk are increased by ACLF but reduced by pre-emptive TIPS</atitle><jtitle>JOURNAL OF HEPATOLOGY</jtitle><date>2020-11</date><risdate>2020</risdate><volume>73</volume><issue>5</issue><spage>1082</spage><epage>1091</epage><pages>1082-1091</pages><issn>0168-8278</issn><abstract>BACKGROUND & AIMS: The relationship between acute-on-chronic liver failure (ACLF) and acute variceal bleeding (AVB) is poorly understood. Specifically, the prevalence and prognosis of ACLF in the context of AVB is unclear, while the role of transjugular intrahepatic portosystemic shunt (TIPS) in the management in patients with ACLF has not been described to date. METHODS: A multicenter, international, observational study was conducted in 2,138 patients from 34 centers between 2011 and 2015. ACLF was defined and graded according to the EASL-CLIF consortium definition. Placement of pre-emptive TIPS (pTIPS) was based on individual center policy. Patients were followed-up for 1 year, until death or liver transplantation. Cox regression and competing risk models (Gray's test) were used to identify independent predictors of rebleeding or mortality. RESULTS: At admission, 380/2,138 (17.8%) patients had ACLF according to EASL-CLIF criteria (grade 1: 38.7%; grade 2: 39.2%; grade 3: 22.1%). The 42-day rebleeding (19% vs. 10%; p <0.001) and mortality (47% vs. 10%; p <0.001) rates were higher in patients with ACLF and increased with ACLF grades. Of note, the presence of ACLF was independently associated with rebleeding and mortality. pTIPS placement improved survival in patients with ACLF at 42 days and 1 year. This effect was also observed in propensity score matching analysis of 66 patients with ACLF, of whom 44 received pTIPs and 22 did not. CONCLUSIONS: This large multicenter international real-life study identified ACLF at admission as an independent predictor of rebleeding and mortality in patients with AVB. Moreover, pTIPS was associated with improved survival in patients with ACLF and AVB. LAY SUMMARY: Acute variceal bleeding is a deadly complication of liver cirrhosis that results from severe portal hypertension. This study demonstrates that the presence of acute-on-chronic liver failure (ACLF) is the strongest predictor of mortality in patients with acute variceal bleeding. Importantly, patients with ACLF and acute variceal (re)bleeding benefit from pre-emptive (early) placement of a transjugular intrahepatic portosystemic shunt.</abstract><pub>ELSEVIER</pub><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0168-8278 |
| ispartof | JOURNAL OF HEPATOLOGY, 2020-11, Vol.73 (5), p.1082-1091 |
| issn | 0168-8278 |
| language | eng |
| recordid | cdi_kuleuven_dspace_123456789_654315 |
| source | Lirias (KU Leuven Association); Access via ScienceDirect (Elsevier) |
| title | Rebleeding and mortality risk are increased by ACLF but reduced by pre-emptive TIPS |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-02T02%3A28%3A58IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-kuleuven&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Rebleeding%20and%20mortality%20risk%20are%20increased%20by%20ACLF%20but%20reduced%20by%20pre-emptive%20TIPS&rft.jtitle=JOURNAL%20OF%20HEPATOLOGY&rft.au=Trebicka,%20Jonel&rft.date=2020-11&rft.volume=73&rft.issue=5&rft.spage=1082&rft.epage=1091&rft.pages=1082-1091&rft.issn=0168-8278&rft_id=info:doi/&rft_dat=%3Ckuleuven%3E123456789_654315%3C/kuleuven%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_id=info:pmid/&rfr_iscdi=true |