RT Journal Article
T1 Rebleeding and mortality risk are increased by ACLF but reduced by pre-emptive TIPS.
A1 Trebicka, Jonel
A1 Gu, Wenyi
A1 Ibáñez-Samaniego, Luis
A1 Hernández-Gea, Virginia
A1 Pitarch, Carla
A1 Garcia, Elisabet
A1 Procopet, Bogdan
A1 Giráldez, Álvaro
A1 Amitrano, Lucio
A1 Villanueva, Candid
A1 Thabut, Dominique
A1 Silva-Junior, Gilberto
A1 Martinez, Javier
A1 Genescà, Joan
A1 Bureau, Cristophe
A1 Llop, Elba
A1 Laleman, Wim
A1 Palazon, Jose Maria
A1 Castellote, Jose
A1 Rodrigues, Susanag
A1 Gluud, Liselotte
A1 Ferreira, Carlos Noronha
A1 Barcelo, Rafael
A1 Cañete, Nuria
A1 Rodríguez, Manuel
A1 Ferlitsch, Arnulf
A1 Mundi, Jose Luis
A1 Gronbaek, Henning
A1 Hernández-Guerra, Manuel
A1 Sassatelli, Romano
A1 Dell'Era, Alessandra
A1 Senzolo, Marco
A1 Abraldes, Juan G
A1 Romero-Gómez, Manuel
A1 Zipprich, Alexander
A1 Casas, Meritxell
A1 Masnou, Helena
A1 Primignani, Massimo
A1 Weiss, Emmanuel
A1 Catalina, Maria-Vega
A1 Erasmus, Hans-Peter
A1 Uschner, Frank Erhard
A1 Schulz, Martin
A1 Brol, Maximilian J
A1 Praktiknjo, Michael
A1 Chang, Johannes
A1 Krag, Aleksander
A1 Nevens, Frederik
A1 Calleja, Jose Luis
A1 Robic, Marie Angèle
A1 Conejo, Irene
A1 Albillos, Agustin
A1 Rudler, Marika
A1 Alvarado, Edilmar
A1 Guardascione, Maria Anna
A1 Tantau, Marcel
A1 Bosch, Jaime
A1 Torres, Ferran
A1 Pavesi, Marco
A1 Garcia-Pagán, Juan Carlos
A1 Jansen, Christian
A1 Bañares, Rafael
A1 International Variceal Bleeding Observational Study Group and Baveno Cooperation, 
K1 Acute variceal bleeding
K1 Acute-on-chronic liver failure
K1 Cirrhosis
K1 Rebleeding
AB 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. 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. 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  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. 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.
YR 2020
FD 2020-04-24
LK http://hdl.handle.net/10668/15445
UL http://hdl.handle.net/10668/15445
LA en
DS RISalud
RD Apr 5, 2025