Acute-on-chronic liver failure ups death risk among patients with failure-to-control OGVB

Acute-on-chronic liver failure (ACLF) worsens survival outlook among patients with failure to control oesophago-gastric variceal bleeding (OGVB), reports a new study.

On the other hand, rescue transjugular intrahepatic stent-shunt (TIPSS) may counter this effect and improve survival in the same patients.

The study included 174 consecutive patients with failure-to-control OGVB, of whom 119 had ACLF. These patients tended to be older, have higher white cell count, and have had more organ failures than their counterparts with acute decompensation (AD; n=55). Rescue TIPSS was defined as a successful operation within 72 hours of OGVB presentation.

At 28 days, 59 patients had died, yielding a mortality rate of 33.9 percent. By the 3-month and 1-year follow-up mark, the respective rates climbed to 41.4 percent and 45.9 percent. At all time-points assessed, mortality was significantly lower in AD than in ACLF patients (p<0.001 for all), and it worsened with increasing ACLF grades (p<0.001).

Survivors at 42 days were significantly younger than non-survivors (p=0.048); on the other hand, respiratory rate (p=0.011) and heart rate (p=0.004) were significantly more deranged in those who died. Levels of serum creatinine, total bilirubin, and white cell count (p<0.001 for all) were also significantly elevated among non-survivors.

Multivariate analysis also found that an ACLF diagnosis significantly and independently increased the risk of 42-day mortality (hazard ratio, 4.580, 95 percent confidence interval, 1.800–11.635; p=0.001). On the other hand, TIPSS significantly improved survival outlook, but only among those with ACLF. Similar patterns of effect were reported for 1-year mortality.