Different risk factors of clinical outcomes between variceal bleeding and non-variceal gastrointestinal bleeding in acutely decompensated cirrhosis

초록

Background and aims: Gastrointestinal bleeding (GIB) including variceal bleeding (VB) and non-variceal gastrointestinal bleeding (NVB) is a major complication in patient with chronic liver disease, especially liver cirrhosis. Recent studies reported that there were no differences in clinical outcomes between VB and NVB. However, larger scale, multicenter, prospective studies were warranted to confirm these results because there was different pathogenic mechanism of development between VB and NVB. We aimed to investigate differences of clinical outcomes and risk factor in cirrhotic patients with GIB. Method: The prospective Korean Acute-On-Chronic Liver Failure (KACLiF) cohort consisted of 1, 773 patients who were hospitalized with acute decompensation of chronic liver disease, from July 2015 to August 2018. We enrolled a total of 490 cirrhotic patient with GIB after excluding non-cirrhotic patients. Patients were then regularly evaluated for adverse outcomes (liver transplantation and death) every 3 month during follow-up period. Results: A total of 490 cirrhotic patient with GIB were included, 414 with VB and 76 with NVB. Patients with NVB had poorer underlying 0liver function than those with VB (bilirubin 4.49 ± 3.96 vs 2.86 ± 3.64 mg/dL, p < 0.001; Child-Pugh score 8 (5–14) vs 7 (5–15), p < 0.001; MELD 16.6 (7–41) vs 13.6 (7–54), p = 0.004; MELD-Na 19.2 (8– 41) vs 15.3 (7–50), p < 0.001). Patients with VB and NVB had similar 28-day adverse outcome (death or liver transplantation) (4.6% vs 6.6%, p = 0.460), 90-day adverse outcome (7.5% vs 13.2%, p = 0.101), 1- year adverse outcome (18.4% vs 19.7%, p = 0.177). MELD was only one predictor for 28-day, 90-day, and 1-year adverse outcome in patients with VB if factors were analysed with ACLF. However, cardiac failure and/or respiratory failure were additional risk factors for 28-day, 90-day, and 1-year adverse outcomes in patients with VB if factors were analysed each statistically important organ failure. Compared to results in patients with VB, MELD was an important predictor for 28-day and 90-day adverse outcomes in patients with NVB. Conclusion: Our results showed no statistically difference of adverse outcomes in cirrhotic patients with VB and NVB. However, there were differences of major predictor for short-term and long-term adverse outcomes between patients with VB and NVB.