Acute variceal bleeding signals poor outcomes in ACLF patients

A new study showed that acute variceal bleeding (AVB) is a signal of poor outcomes in patients with acute-on-chronic liver failure (ACLF). An elevated baseline hepatic venous pressure gradient (HVPG) represents an early and potential therapeutic target to improve outcomes in these patients, according to a presentation at The Liver Meeting 2021.

The study evaluated the outcomes of AVB occurring in patients with ACLF in a multinational cohort of APASL ACLF research consortium (AARC). The retrospective analysis was conducted using the AARC database on patients with ACLF who subsequently developed AVB (ACLF-AVB). These patients were compared to a cohort of patients with ACLF matched for severity of liver disease with AVB. Two main outcomes were rebleeding and mortality in 6-weeks.

The study included 4434 ACLP patients. The 6-week mortality in ACLF-AVB and ACLF-without AVB was 70.8% and 53.8%, respectively. The major causes of deaths in ACLF-AVB were new onset organ failures (77%) and rebleeding (23%). Ascites, AVB, and MELD score independently predicted mortality in the overall ACLF cohort.

Reference
Agarwal S, et al. Acute variceal bleeding portends poor outcomes in patients with acute-on-chronic liver failure: A propensity score matched study from APASL ACLF Research Consortium (AARC). Presented at: American Association for the Study of Liver Diseases (AASLD) The Liver Meeting (TLM) 2021.