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Volume 38 Issue 11
Nov.  2022
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Article Navigation >  Journal of Clinical Hepatology  > 2022  >  38(11): 2532-2536

Risk factors for acute variceal bleeding in acute-on-chronic liver failure and its influence on prognosis

DOI: 10.3969/j.issn.1001-5256.2022.11.018

  • Department of Liver Diseases, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China

Research funding:

The 13th Five-Year National Science and Technology Major Project for Infectious Diseases (2017ZX10203201-004)

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  • Corresponding author: YOU Shaoli, youshaoli1972@163.com(ORCID: 0000-0001-8689-8509)
  • Received Date: 2022-05-05
  • Accepted Date: 2022-06-20
  • Published Date: 2022-11-20
    Abstract
  •   Objective  To investigate the risk factors for acute variceal bleeding (AVB) in acute-on-chronic liver failure (ACLF) and its influence on prognosis.  Methods  A total of 1409 ACLF patients who were admitted to The Fifth Medical Center of Chinese PLA General Hospital from 2009 to 2015 were followed up for 6 months, and according to the presence or absence of AVB, they were divided into AVB group and non-AVB group. The Student's t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups. The Kaplan-Meier curves were plotted and the Log-rank test was performed to analyze mortality rate and progression during follow-up, and a binary Logistic regression analysis was used to investigate the risk factors for AVB.  Results  Among these 1409 patients, 167 (11.85%) experienced AVB. The 30-day survival rate was 43.42% in the AVB group and 67.79% in the non-AVB group (χ2=33.558, P < 0.001), and the 180-day survival rate was 18.91% in the AVB group and 53.97% in the non-AVB group (χ2=76.881, P < 0.001). The Log-rank test showed significant differences in 30- and 180-day survival rates between the AVB group and the non-AVB group (χ2=40.950 and 89.320, both P < 0.05). The Logistic regression analysis showed that pleural effusion (odds ratio [OR]=1.522, 95% confidence interval [CI]: 1.071-2.162, P=0.019), acute kidney injury (AKI) (OR=2.201, 95%CI: 1.415-3.426, P < 0.001), ABC subtype of ACLF (OR=2.491, 95%CI: 1.489-4.168, P=0.001), ACLF stage (OR=2.403, 95%CI: 1.687-3.421, P < 0.001), and urea(OR=2.567, 95%CI: 1.570-4.196, P < 0.001)were independently associated with AVB in ACLF patients.  Conclusion  AVB is an important influencing factor for the short-term survival of ACLF patients, and pleural effusion, AKI, BC subtype of ACLF, advanced ACLF, and urea are independent risk factors for the onset of AVB.

     

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