Rebleeding and mortality risk are increased by ACLF but reduced by pre-emptive TIPS
Rebleeding and mortality risk are increased by ACLF but reduced by pre-emptive TIPS
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DOI：
10.1016/j.jhep.2020.04.024
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发表时间：
2020-11-01
影响因子：
25.7
通讯作者：
Banares, Rafael
中科院分区：
文献类型：
--
作者：
Trebicka, Jonel;Gu, Wenyi;Banares, Rafael
背景与目的：人们对慢加急性肝衰竭（ACLF）和急性静脉曲张出血（AVB）之间的关系知之甚少。具体而言，ACLF的患病率和预后的AVB的背景下还不清楚，而经颈静脉肝内门体分流术（TIPS）在ACLF患者的管理中的作用还没有被描述到data.Methods：一个多中心，国际，观察性研究进行了2,138例患者从34个中心之间2011年和2015年。根据EASL-CLIF联盟的定义对ACLF进行定义和分级。优先TIPS（pTIPS）的放置基于个体中心政策。随访1年，直至死亡或肝移植。考克斯回归和竞争风险模型（格雷检验）被用来确定再出血或mortarity.Results的独立预测因素：在入院时，380/2,138（17.8%）患者有ACLF根据EASL-CLIF标准（1级：38.7%; 2级：39.2%; 3级：22.1%）。42天再出血（19% vs. 10%; p
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 trans-jugular 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