Risk factors for acute variceal bleeding in acute-on-chronic liver failure and its influence on prognosis
10.3969/j.issn.1001-5256.2022.11.018
- VernacularTitle:慢加急性肝衰竭急性静脉曲张出血的危险因素及预后分析
- Author:
Wanshu LIU
1
;
Lijun SHEN
1
;
Qinghui ZHAI
1
;
Shaojie XIN
1
;
Shaoli YOU
1
Author Information
1. Department of Liver Diseases, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
- Publication Type:Original Articles_Other Liver Diseases
- Keywords:
Acute-On-Chronic Liver Failure;
Varicose Veins;
Risk Factors;
Prognosis
- From:
Journal of Clinical Hepatology
2022;38(11):2532-2536
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the risk factors for acute variceal bleeding (AVB) in acute-on-chronic liver failure (ACLF) and its influence on prognosis. Methods A total of 1409 ACLF patients who were admitted to The Fifth Medical Center of Chinese PLA General Hospital from 2009 to 2015 were followed up for 6 months, and according to the presence or absence of AVB, they were divided into AVB group and non-AVB group. The Student's t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups. The Kaplan-Meier curves were plotted and the Log-rank test was performed to analyze mortality rate and progression during follow-up, and a binary Logistic regression analysis was used to investigate the risk factors for AVB. Results Among these 1409 patients, 167 (11.85%) experienced AVB. The 30-day survival rate was 43.42% in the AVB group and 67.79% in the non-AVB group ( χ 2 =33.558, P < 0.001), and the 180-day survival rate was 18.91% in the AVB group and 53.97% in the non-AVB group ( χ 2 =76.881, P < 0.001). The Log-rank test showed significant differences in 30- and 180-day survival rates between the AVB group and the non-AVB group ( χ 2 =40.950 and 89.320, both P < 0.05). The Logistic regression analysis showed that pleural effusion (odds ratio [ OR ]=1.522, 95% confidence interval [ CI ]: 1.071-2.162, P =0.019), acute kidney injury (AKI) ( OR =2.201, 95% CI : 1.415-3.426, P < 0.001), ABC subtype of ACLF ( OR =2.491, 95% CI : 1.489-4.168, P =0.001), ACLF stage ( OR =2.403, 95% CI : 1.687-3.421, P < 0.001), and urea( OR =2.567, 95% CI : 1.570-4.196, P < 0.001)were independently associated with AVB in ACLF patients. Conclusion AVB is an important influencing factor for the short-term survival of ACLF patients, and pleural effusion, AKI, BC subtype of ACLF, advanced ACLF, and urea are independent risk factors for the onset of AVB.
