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Cited 12 time in webofscience Cited 13 time in scopus
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Acute-on-chronic liver failure as a major predictive factor for mortality in patients with variceal bleeding

Authors
Shin, JongbeomYu, Jung HwanJin, Young-JooYim, Hyung JoonJung, Young KulYang, Jin MoSong, SeonKim, Young SeokKim, Sang GyuneKim, Dong JoonSuk, Ki TaeYoon, Eileen L.Lee, Sang SooKim, Chang WookKim, Hee YeonJang, Jae YoungJeong, Soung Won
Issue Date
Oct-2020
Publisher
대한간학회
Keywords
Acute-on; chronic liver failure; Variceal bleeding; Prognosis; Sequential organ failure assessment
Citation
Clinical and Molecular Hepatology, v.26, no.4, pp.540 - 553
Indexed
SCIE
SCOPUS
KCI
Journal Title
Clinical and Molecular Hepatology
Volume
26
Number
4
Start Page
540
End Page
553
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/49234
DOI
10.3350/cmh.2020.0034
ISSN
2287-2728
Abstract
Background/Aims: This study examined the risk factors associated with mortality in cirrhotic patients hospitalized with variceal bleeding, and evaluated the effects of acute-on-chronic liver failure (ACLF) on the prognosis of these patients. Methods: This study was retrospectively conducted on patients registered in the Korean acute- on-chronic liver failure study cohort, and on 474 consecutive cirrhotic patients hospitalized with variceal bleeding from January 2013 to December 2013 at 21 university hospitals. ACLF was defined as described by the European Association for the Study of Liver-Chronic Liver Failure Consortium. Results: Among a total of 474 patients, 61 patients were diagnosed with ACLF. The cumulative overall survival (OS) rate was lower in the patients with ACLF than in those without (P<0.001), and patients with higher ACLF grades had a lower OS rate (P<0.001). The chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score was identified as a significant prognostic factor in patients hospitalized with variceal bleeding (hazard ratio [HR], 1.40; 95% confidence interval [CI], 1.30-1.50; P<0.001), even in ACLF patients with variceal bleeding (HR, 1.32; 95% CI, 1.19-1.46, P<0.001). Concerning the prediction of the mortality risk at 28- and 90-day using CLIF-SOFA scores, c-statistics were 0.895 (95% CI, 0.829-0.962) and 0.897 (95% CI, 0.842- 0.951), respectively, and the optimal cut-off values were 6.5 and 6.5, respectively. Conclusions: In cirrhotic patients hospitalized with variceal bleeding, the prognosis was poor when accompanied by ACLF, especially depending upon CLIF-SOFA score. CLIF-SOFA model well predicted the 28- day or 90-day mortality for cirrhotic patients who experienced variceal bleeding.
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Jung, Young Kul
Ansan Hospital (Department of Gastroenterology and Hepatology, Ansan Hospital)
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