Risk Stratification Based on Chronic Liver Failure Consortium Acute Decompensation Score in Patients With Child‐Pugh B Cirrhosis and Acute Variceal Bleeding
Background and Aims Optimal candidates for early transjugular intrahepatic portosystemic shunt (TIPS) in patients with Child‐Pugh B cirrhosis and acute variceal bleeding (AVB) remain unclear. This study aimed to test the hypothesis that risk stratification using the Chronic Liver Failure Consortium...
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| Veröffentlicht in: | Hepatology (Baltimore, Md.) Md.), 2021-04, Vol.73 (4), p.1478-1493 |
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| creator | Lv, Yong Wang, Zhengyu Li, Kai Wang, Qiuhe Bai, Wei Yuan, Xulong Yu, Tianlei Niu, Jing Yang, Zhiping Zhu, Xuan Zhao, Jianbo Xue, Hui Jiang, Zaibo Zhuge, Yuzheng Zhang, Chunqing Sun, Junhui Ding, Pengxu Ren, Weixin Li, Yingchun Zhang, Kewei Zhang, Wenguang Guo, Wengang Luo, Bohan Li, Xiaomei Yuan, Jie Han, Na Zhu, Ying He, Chuangye Yin, Zhanxin Fan, Daiming Han, Guohong |
| description | Background and Aims
Optimal candidates for early transjugular intrahepatic portosystemic shunt (TIPS) in patients with Child‐Pugh B cirrhosis and acute variceal bleeding (AVB) remain unclear. This study aimed to test the hypothesis that risk stratification using the Chronic Liver Failure Consortium Acute Decompensation score (CLIF‐C ADs) may be useful to identify a subgroup at high risk of mortality or further bleeding that may benefit from early TIPS in patients with Child‐Pugh B cirrhosis and AVB.
Approach and Results
We analyzed the pooled individual data from two previous studies of 608 patients with Child‐Pugh B cirrhosis and AVB who received standard treatment between 2010 and 2017 in China. The concordance index values of CLIF‐C ADs for 6‐week and 1‐year mortality (0.715 and 0.708) were significantly better than those of active bleeding at endoscopy (0.633 [P |
| doi_str_mv | 10.1002/hep.31478 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2427297732</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2427297732</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3538-120664fc01b257fac6133ec6b2188cb062b5b1237f070a26b571b4bfdef72e3f3</originalsourceid><addsrcrecordid>eNp1kc1u1DAQxy0EokvhwAsgS1zgkNYfiZ0cu6GllVbqivJxtBxn0rgk9mInoN54BJ6Ah-NJasjSAxIXj0fzm59G-iP0nJIjSgg77mF3xGkuywdoRQsmM84L8hCtCJMkqyivDtCTGG8IIVXOysfogKeBqIhYoZ_vbPyMr6agJ9tZk17v8FpHaHH61H3wzhq8sV8h4DNthzkArr2LPkx2HvGJmSfAb8D4cQcuLutXxifKOrxNPbgp4k926pPMDu2v7z-283WP17i2IfQ-2oi1a_eijzpYA3rA6wGgte76KXrU6SHCs309RB_OTt_X59nm8u1FfbLJDC94mVFGhMg7Q2jDCtlpIyjnYETDaFmahgjWFA1lXHZEEs1EU0ja5E3XQicZ8I4foleLdxf8lxnipEYbDQyDduDnqFjOJKuk5CyhL_9Bb_wcXLpOsYIyKqSgNFGvF8oEH2OATu2CHXW4VZSo36GpFJr6E1piX-yNczNCe0_-TSkBxwvwzQ5w-3-TOj_dLso74ASiRA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2512167611</pqid></control><display><type>article</type><title>Risk Stratification Based on Chronic Liver Failure Consortium Acute Decompensation Score in Patients With Child‐Pugh B Cirrhosis and Acute Variceal Bleeding</title><source>MEDLINE</source><source>Wiley Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><creator>Lv, Yong ; Wang, Zhengyu ; Li, Kai ; Wang, Qiuhe ; Bai, Wei ; Yuan, Xulong ; Yu, Tianlei ; Niu, Jing ; Yang, Zhiping ; Zhu, Xuan ; Zhao, Jianbo ; Xue, Hui ; Jiang, Zaibo ; Zhuge, Yuzheng ; Zhang, Chunqing ; Sun, Junhui ; Ding, Pengxu ; Ren, Weixin ; Li, Yingchun ; Zhang, Kewei ; Zhang, Wenguang ; Guo, Wengang ; Luo, Bohan ; Li, Xiaomei ; Yuan, Jie ; Han, Na ; Zhu, Ying ; He, Chuangye ; Yin, Zhanxin ; Fan, Daiming ; Han, Guohong</creator><creatorcontrib>Lv, Yong ; Wang, Zhengyu ; Li, Kai ; Wang, Qiuhe ; Bai, Wei ; Yuan, Xulong ; Yu, Tianlei ; Niu, Jing ; Yang, Zhiping ; Zhu, Xuan ; Zhao, Jianbo ; Xue, Hui ; Jiang, Zaibo ; Zhuge, Yuzheng ; Zhang, Chunqing ; Sun, Junhui ; Ding, Pengxu ; Ren, Weixin ; Li, Yingchun ; Zhang, Kewei ; Zhang, Wenguang ; Guo, Wengang ; Luo, Bohan ; Li, Xiaomei ; Yuan, Jie ; Han, Na ; Zhu, Ying ; He, Chuangye ; Yin, Zhanxin ; Fan, Daiming ; Han, Guohong</creatorcontrib><description>Background and Aims
Optimal candidates for early transjugular intrahepatic portosystemic shunt (TIPS) in patients with Child‐Pugh B cirrhosis and acute variceal bleeding (AVB) remain unclear. This study aimed to test the hypothesis that risk stratification using the Chronic Liver Failure Consortium Acute Decompensation score (CLIF‐C ADs) may be useful to identify a subgroup at high risk of mortality or further bleeding that may benefit from early TIPS in patients with Child‐Pugh B cirrhosis and AVB.
Approach and Results
We analyzed the pooled individual data from two previous studies of 608 patients with Child‐Pugh B cirrhosis and AVB who received standard treatment between 2010 and 2017 in China. The concordance index values of CLIF‐C ADs for 6‐week and 1‐year mortality (0.715 and 0.708) were significantly better than those of active bleeding at endoscopy (0.633 [P < 0.001] and 0.556 [P < 0.001]) and other prognostic models. With X‐tile software identifying an optimal cutoff value, patients were categorized as low risk (CLIF‐C ADs <48), intermediate risk (CLIF‐C ADs 48‐56), and high risk (CLIF‐C ADs >56), with a 5.6%, 16.8%, and 25.4% risk of 6‐week death, respectively. Nevertheless, the performance of CLIF‐C ADs for predicting a composite endpoint of 6‐week death or further bleeding was not satisfactory (area under the receiver operating characteristics curve [AUC], 0.588). A nomogram incorporating components of CLIF‐C ADs and albumin, platelet, active bleeding, and ascites significantly improved the prediction accuracy (AUC, 0.725).
Conclusions
In patients with Child‐Pugh B cirrhosis and AVB, risk stratification using CLIF‐C ADs identifies a subgroup with high risk of death that may derive survival benefit from early TIPS. With improved prediction accuracy for 6‐week death or further bleeding, the data‐driven nomogram may help to stratify patients in randomized trials. Future external validation of these findings in patients with different etiologies is required.</description><identifier>ISSN: 0270-9139</identifier><identifier>EISSN: 1527-3350</identifier><identifier>DOI: 10.1002/hep.31478</identifier><identifier>PMID: 32706906</identifier><language>eng</language><publisher>United States: Wolters Kluwer Health, Inc</publisher><subject>Acute Disease - epidemiology ; Acute-On-Chronic Liver Failure ; Adult ; Aged ; Ascites ; Bleeding ; China - epidemiology ; Cirrhosis ; Clinical trials ; Comorbidity ; Consortia ; Death ; Endoscopy ; Esophageal and Gastric Varices - epidemiology ; Esophageal and Gastric Varices - mortality ; Esophageal and Gastric Varices - surgery ; Female ; Follow-Up Studies ; Gastrointestinal Hemorrhage - epidemiology ; Gastrointestinal Hemorrhage - mortality ; Gastrointestinal Hemorrhage - surgery ; Hepatology ; Humans ; Liver cirrhosis ; Liver Cirrhosis - epidemiology ; Liver failure ; Male ; Middle Aged ; Mortality ; Nomograms ; Portasystemic Shunt, Transjugular Intrahepatic - methods ; Prognosis ; Prospective Studies ; Research Design ; Retrospective Studies ; Risk Assessment ; Treatment Outcome</subject><ispartof>Hepatology (Baltimore, Md.), 2021-04, Vol.73 (4), p.1478-1493</ispartof><rights>2020 by the American Association for the Study of Liver Diseases.</rights><rights>2021 by the American Association for the Study of Liver Diseases.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3538-120664fc01b257fac6133ec6b2188cb062b5b1237f070a26b571b4bfdef72e3f3</citedby><cites>FETCH-LOGICAL-c3538-120664fc01b257fac6133ec6b2188cb062b5b1237f070a26b571b4bfdef72e3f3</cites><orcidid>0000-0003-4568-3776</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fhep.31478$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fhep.31478$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32706906$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lv, Yong</creatorcontrib><creatorcontrib>Wang, Zhengyu</creatorcontrib><creatorcontrib>Li, Kai</creatorcontrib><creatorcontrib>Wang, Qiuhe</creatorcontrib><creatorcontrib>Bai, Wei</creatorcontrib><creatorcontrib>Yuan, Xulong</creatorcontrib><creatorcontrib>Yu, Tianlei</creatorcontrib><creatorcontrib>Niu, Jing</creatorcontrib><creatorcontrib>Yang, Zhiping</creatorcontrib><creatorcontrib>Zhu, Xuan</creatorcontrib><creatorcontrib>Zhao, Jianbo</creatorcontrib><creatorcontrib>Xue, Hui</creatorcontrib><creatorcontrib>Jiang, Zaibo</creatorcontrib><creatorcontrib>Zhuge, Yuzheng</creatorcontrib><creatorcontrib>Zhang, Chunqing</creatorcontrib><creatorcontrib>Sun, Junhui</creatorcontrib><creatorcontrib>Ding, Pengxu</creatorcontrib><creatorcontrib>Ren, Weixin</creatorcontrib><creatorcontrib>Li, Yingchun</creatorcontrib><creatorcontrib>Zhang, Kewei</creatorcontrib><creatorcontrib>Zhang, Wenguang</creatorcontrib><creatorcontrib>Guo, Wengang</creatorcontrib><creatorcontrib>Luo, Bohan</creatorcontrib><creatorcontrib>Li, Xiaomei</creatorcontrib><creatorcontrib>Yuan, Jie</creatorcontrib><creatorcontrib>Han, Na</creatorcontrib><creatorcontrib>Zhu, Ying</creatorcontrib><creatorcontrib>He, Chuangye</creatorcontrib><creatorcontrib>Yin, Zhanxin</creatorcontrib><creatorcontrib>Fan, Daiming</creatorcontrib><creatorcontrib>Han, Guohong</creatorcontrib><title>Risk Stratification Based on Chronic Liver Failure Consortium Acute Decompensation Score in Patients With Child‐Pugh B Cirrhosis and Acute Variceal Bleeding</title><title>Hepatology (Baltimore, Md.)</title><addtitle>Hepatology</addtitle><description>Background and Aims
Optimal candidates for early transjugular intrahepatic portosystemic shunt (TIPS) in patients with Child‐Pugh B cirrhosis and acute variceal bleeding (AVB) remain unclear. This study aimed to test the hypothesis that risk stratification using the Chronic Liver Failure Consortium Acute Decompensation score (CLIF‐C ADs) may be useful to identify a subgroup at high risk of mortality or further bleeding that may benefit from early TIPS in patients with Child‐Pugh B cirrhosis and AVB.
Approach and Results
We analyzed the pooled individual data from two previous studies of 608 patients with Child‐Pugh B cirrhosis and AVB who received standard treatment between 2010 and 2017 in China. The concordance index values of CLIF‐C ADs for 6‐week and 1‐year mortality (0.715 and 0.708) were significantly better than those of active bleeding at endoscopy (0.633 [P < 0.001] and 0.556 [P < 0.001]) and other prognostic models. With X‐tile software identifying an optimal cutoff value, patients were categorized as low risk (CLIF‐C ADs <48), intermediate risk (CLIF‐C ADs 48‐56), and high risk (CLIF‐C ADs >56), with a 5.6%, 16.8%, and 25.4% risk of 6‐week death, respectively. Nevertheless, the performance of CLIF‐C ADs for predicting a composite endpoint of 6‐week death or further bleeding was not satisfactory (area under the receiver operating characteristics curve [AUC], 0.588). A nomogram incorporating components of CLIF‐C ADs and albumin, platelet, active bleeding, and ascites significantly improved the prediction accuracy (AUC, 0.725).
Conclusions
In patients with Child‐Pugh B cirrhosis and AVB, risk stratification using CLIF‐C ADs identifies a subgroup with high risk of death that may derive survival benefit from early TIPS. With improved prediction accuracy for 6‐week death or further bleeding, the data‐driven nomogram may help to stratify patients in randomized trials. Future external validation of these findings in patients with different etiologies is required.</description><subject>Acute Disease - epidemiology</subject><subject>Acute-On-Chronic Liver Failure</subject><subject>Adult</subject><subject>Aged</subject><subject>Ascites</subject><subject>Bleeding</subject><subject>China - epidemiology</subject><subject>Cirrhosis</subject><subject>Clinical trials</subject><subject>Comorbidity</subject><subject>Consortia</subject><subject>Death</subject><subject>Endoscopy</subject><subject>Esophageal and Gastric Varices - epidemiology</subject><subject>Esophageal and Gastric Varices - mortality</subject><subject>Esophageal and Gastric Varices - surgery</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gastrointestinal Hemorrhage - epidemiology</subject><subject>Gastrointestinal Hemorrhage - mortality</subject><subject>Gastrointestinal Hemorrhage - surgery</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Liver cirrhosis</subject><subject>Liver Cirrhosis - epidemiology</subject><subject>Liver failure</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Nomograms</subject><subject>Portasystemic Shunt, Transjugular Intrahepatic - methods</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Research Design</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Treatment Outcome</subject><issn>0270-9139</issn><issn>1527-3350</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kc1u1DAQxy0EokvhwAsgS1zgkNYfiZ0cu6GllVbqivJxtBxn0rgk9mInoN54BJ6Ah-NJasjSAxIXj0fzm59G-iP0nJIjSgg77mF3xGkuywdoRQsmM84L8hCtCJMkqyivDtCTGG8IIVXOysfogKeBqIhYoZ_vbPyMr6agJ9tZk17v8FpHaHH61H3wzhq8sV8h4DNthzkArr2LPkx2HvGJmSfAb8D4cQcuLutXxifKOrxNPbgp4k926pPMDu2v7z-283WP17i2IfQ-2oi1a_eijzpYA3rA6wGgte76KXrU6SHCs309RB_OTt_X59nm8u1FfbLJDC94mVFGhMg7Q2jDCtlpIyjnYETDaFmahgjWFA1lXHZEEs1EU0ja5E3XQicZ8I4foleLdxf8lxnipEYbDQyDduDnqFjOJKuk5CyhL_9Bb_wcXLpOsYIyKqSgNFGvF8oEH2OATu2CHXW4VZSo36GpFJr6E1piX-yNczNCe0_-TSkBxwvwzQ5w-3-TOj_dLso74ASiRA</recordid><startdate>202104</startdate><enddate>202104</enddate><creator>Lv, Yong</creator><creator>Wang, Zhengyu</creator><creator>Li, Kai</creator><creator>Wang, Qiuhe</creator><creator>Bai, Wei</creator><creator>Yuan, Xulong</creator><creator>Yu, Tianlei</creator><creator>Niu, Jing</creator><creator>Yang, Zhiping</creator><creator>Zhu, Xuan</creator><creator>Zhao, Jianbo</creator><creator>Xue, Hui</creator><creator>Jiang, Zaibo</creator><creator>Zhuge, Yuzheng</creator><creator>Zhang, Chunqing</creator><creator>Sun, Junhui</creator><creator>Ding, Pengxu</creator><creator>Ren, Weixin</creator><creator>Li, Yingchun</creator><creator>Zhang, Kewei</creator><creator>Zhang, Wenguang</creator><creator>Guo, Wengang</creator><creator>Luo, Bohan</creator><creator>Li, Xiaomei</creator><creator>Yuan, Jie</creator><creator>Han, Na</creator><creator>Zhu, Ying</creator><creator>He, Chuangye</creator><creator>Yin, Zhanxin</creator><creator>Fan, Daiming</creator><creator>Han, Guohong</creator><general>Wolters Kluwer Health, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TM</scope><scope>7TO</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4568-3776</orcidid></search><sort><creationdate>202104</creationdate><title>Risk Stratification Based on Chronic Liver Failure Consortium Acute Decompensation Score in Patients With Child‐Pugh B Cirrhosis and Acute Variceal Bleeding</title><author>Lv, Yong ; Wang, Zhengyu ; Li, Kai ; Wang, Qiuhe ; Bai, Wei ; Yuan, Xulong ; Yu, Tianlei ; Niu, Jing ; Yang, Zhiping ; Zhu, Xuan ; Zhao, Jianbo ; Xue, Hui ; Jiang, Zaibo ; Zhuge, Yuzheng ; Zhang, Chunqing ; Sun, Junhui ; Ding, Pengxu ; Ren, Weixin ; Li, Yingchun ; Zhang, Kewei ; Zhang, Wenguang ; Guo, Wengang ; Luo, Bohan ; Li, Xiaomei ; Yuan, Jie ; Han, Na ; Zhu, Ying ; He, Chuangye ; Yin, Zhanxin ; Fan, Daiming ; Han, Guohong</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3538-120664fc01b257fac6133ec6b2188cb062b5b1237f070a26b571b4bfdef72e3f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Acute Disease - epidemiology</topic><topic>Acute-On-Chronic Liver Failure</topic><topic>Adult</topic><topic>Aged</topic><topic>Ascites</topic><topic>Bleeding</topic><topic>China - epidemiology</topic><topic>Cirrhosis</topic><topic>Clinical trials</topic><topic>Comorbidity</topic><topic>Consortia</topic><topic>Death</topic><topic>Endoscopy</topic><topic>Esophageal and Gastric Varices - epidemiology</topic><topic>Esophageal and Gastric Varices - mortality</topic><topic>Esophageal and Gastric Varices - surgery</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gastrointestinal Hemorrhage - epidemiology</topic><topic>Gastrointestinal Hemorrhage - mortality</topic><topic>Gastrointestinal Hemorrhage - surgery</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Liver cirrhosis</topic><topic>Liver Cirrhosis - epidemiology</topic><topic>Liver failure</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Nomograms</topic><topic>Portasystemic Shunt, Transjugular Intrahepatic - methods</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Research Design</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lv, Yong</creatorcontrib><creatorcontrib>Wang, Zhengyu</creatorcontrib><creatorcontrib>Li, Kai</creatorcontrib><creatorcontrib>Wang, Qiuhe</creatorcontrib><creatorcontrib>Bai, Wei</creatorcontrib><creatorcontrib>Yuan, Xulong</creatorcontrib><creatorcontrib>Yu, Tianlei</creatorcontrib><creatorcontrib>Niu, Jing</creatorcontrib><creatorcontrib>Yang, Zhiping</creatorcontrib><creatorcontrib>Zhu, Xuan</creatorcontrib><creatorcontrib>Zhao, Jianbo</creatorcontrib><creatorcontrib>Xue, Hui</creatorcontrib><creatorcontrib>Jiang, Zaibo</creatorcontrib><creatorcontrib>Zhuge, Yuzheng</creatorcontrib><creatorcontrib>Zhang, Chunqing</creatorcontrib><creatorcontrib>Sun, Junhui</creatorcontrib><creatorcontrib>Ding, Pengxu</creatorcontrib><creatorcontrib>Ren, Weixin</creatorcontrib><creatorcontrib>Li, Yingchun</creatorcontrib><creatorcontrib>Zhang, Kewei</creatorcontrib><creatorcontrib>Zhang, Wenguang</creatorcontrib><creatorcontrib>Guo, Wengang</creatorcontrib><creatorcontrib>Luo, Bohan</creatorcontrib><creatorcontrib>Li, Xiaomei</creatorcontrib><creatorcontrib>Yuan, Jie</creatorcontrib><creatorcontrib>Han, Na</creatorcontrib><creatorcontrib>Zhu, Ying</creatorcontrib><creatorcontrib>He, Chuangye</creatorcontrib><creatorcontrib>Yin, Zhanxin</creatorcontrib><creatorcontrib>Fan, Daiming</creatorcontrib><creatorcontrib>Han, Guohong</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Hepatology (Baltimore, Md.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lv, Yong</au><au>Wang, Zhengyu</au><au>Li, Kai</au><au>Wang, Qiuhe</au><au>Bai, Wei</au><au>Yuan, Xulong</au><au>Yu, Tianlei</au><au>Niu, Jing</au><au>Yang, Zhiping</au><au>Zhu, Xuan</au><au>Zhao, Jianbo</au><au>Xue, Hui</au><au>Jiang, Zaibo</au><au>Zhuge, Yuzheng</au><au>Zhang, Chunqing</au><au>Sun, Junhui</au><au>Ding, Pengxu</au><au>Ren, Weixin</au><au>Li, Yingchun</au><au>Zhang, Kewei</au><au>Zhang, Wenguang</au><au>Guo, Wengang</au><au>Luo, Bohan</au><au>Li, Xiaomei</au><au>Yuan, Jie</au><au>Han, Na</au><au>Zhu, Ying</au><au>He, Chuangye</au><au>Yin, Zhanxin</au><au>Fan, Daiming</au><au>Han, Guohong</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk Stratification Based on Chronic Liver Failure Consortium Acute Decompensation Score in Patients With Child‐Pugh B Cirrhosis and Acute Variceal Bleeding</atitle><jtitle>Hepatology (Baltimore, Md.)</jtitle><addtitle>Hepatology</addtitle><date>2021-04</date><risdate>2021</risdate><volume>73</volume><issue>4</issue><spage>1478</spage><epage>1493</epage><pages>1478-1493</pages><issn>0270-9139</issn><eissn>1527-3350</eissn><abstract>Background and Aims
Optimal candidates for early transjugular intrahepatic portosystemic shunt (TIPS) in patients with Child‐Pugh B cirrhosis and acute variceal bleeding (AVB) remain unclear. This study aimed to test the hypothesis that risk stratification using the Chronic Liver Failure Consortium Acute Decompensation score (CLIF‐C ADs) may be useful to identify a subgroup at high risk of mortality or further bleeding that may benefit from early TIPS in patients with Child‐Pugh B cirrhosis and AVB.
Approach and Results
We analyzed the pooled individual data from two previous studies of 608 patients with Child‐Pugh B cirrhosis and AVB who received standard treatment between 2010 and 2017 in China. The concordance index values of CLIF‐C ADs for 6‐week and 1‐year mortality (0.715 and 0.708) were significantly better than those of active bleeding at endoscopy (0.633 [P < 0.001] and 0.556 [P < 0.001]) and other prognostic models. With X‐tile software identifying an optimal cutoff value, patients were categorized as low risk (CLIF‐C ADs <48), intermediate risk (CLIF‐C ADs 48‐56), and high risk (CLIF‐C ADs >56), with a 5.6%, 16.8%, and 25.4% risk of 6‐week death, respectively. Nevertheless, the performance of CLIF‐C ADs for predicting a composite endpoint of 6‐week death or further bleeding was not satisfactory (area under the receiver operating characteristics curve [AUC], 0.588). A nomogram incorporating components of CLIF‐C ADs and albumin, platelet, active bleeding, and ascites significantly improved the prediction accuracy (AUC, 0.725).
Conclusions
In patients with Child‐Pugh B cirrhosis and AVB, risk stratification using CLIF‐C ADs identifies a subgroup with high risk of death that may derive survival benefit from early TIPS. With improved prediction accuracy for 6‐week death or further bleeding, the data‐driven nomogram may help to stratify patients in randomized trials. Future external validation of these findings in patients with different etiologies is required.</abstract><cop>United States</cop><pub>Wolters Kluwer Health, Inc</pub><pmid>32706906</pmid><doi>10.1002/hep.31478</doi><tpages>16</tpages><orcidid>https://orcid.org/0000-0003-4568-3776</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0270-9139 |
| ispartof | Hepatology (Baltimore, Md.), 2021-04, Vol.73 (4), p.1478-1493 |
| issn | 0270-9139 1527-3350 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2427297732 |
| source | MEDLINE; Wiley Journals; EZB-FREE-00999 freely available EZB journals |
| subjects | Acute Disease - epidemiology Acute-On-Chronic Liver Failure Adult Aged Ascites Bleeding China - epidemiology Cirrhosis Clinical trials Comorbidity Consortia Death Endoscopy Esophageal and Gastric Varices - epidemiology Esophageal and Gastric Varices - mortality Esophageal and Gastric Varices - surgery Female Follow-Up Studies Gastrointestinal Hemorrhage - epidemiology Gastrointestinal Hemorrhage - mortality Gastrointestinal Hemorrhage - surgery Hepatology Humans Liver cirrhosis Liver Cirrhosis - epidemiology Liver failure Male Middle Aged Mortality Nomograms Portasystemic Shunt, Transjugular Intrahepatic - methods Prognosis Prospective Studies Research Design Retrospective Studies Risk Assessment Treatment Outcome |
| title | Risk Stratification Based on Chronic Liver Failure Consortium Acute Decompensation Score in Patients With Child‐Pugh B Cirrhosis and Acute Variceal Bleeding |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-05T04%3A53%3A59IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Risk%20Stratification%20Based%20on%20Chronic%20Liver%20Failure%20Consortium%20Acute%20Decompensation%20Score%20in%20Patients%20With%20Child%E2%80%90Pugh%20B%20Cirrhosis%20and%20Acute%20Variceal%20Bleeding&rft.jtitle=Hepatology%20(Baltimore,%20Md.)&rft.au=Lv,%20Yong&rft.date=2021-04&rft.volume=73&rft.issue=4&rft.spage=1478&rft.epage=1493&rft.pages=1478-1493&rft.issn=0270-9139&rft.eissn=1527-3350&rft_id=info:doi/10.1002/hep.31478&rft_dat=%3Cproquest_cross%3E2427297732%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2512167611&rft_id=info:pmid/32706906&rfr_iscdi=true |