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dc.creatorTrebicka, Joneles
dc.creatorGu, Wenyies
dc.creatorIbáñez-Samaniego, Luises
dc.creatorHernández-Gea, Virginiaes
dc.creatorPitarch, Carlaes
dc.creatorGarcia, Elisabetes
dc.creatorRomero Gómez, Manueles
dc.creatorBañares, Rafaeles
dc.date.accessioned2023-06-13T10:11:18Z
dc.date.available2023-06-13T10:11:18Z
dc.date.issued2020
dc.identifier.citationTrebicka, J., Gu, W., Ibáñez-Samaniego, L., Hernández-Gea, V., Pitarch, C., Garcia, E.,...,Bañares, R. (2020). Rebleeding and mortality risk are increased by ACLF but reduced by pre-emptive TIPS. Journal of Hepatology, 73 (5), 1082-1091. https://doi.org/10.1016/j.jhep.2020.04.024.
dc.identifier.issn0168-8278es
dc.identifier.issn1600-0641es
dc.identifier.urihttps://hdl.handle.net/11441/147154
dc.description.abstractBackground & Aims: The relationship between acute-on-chronic liver failure (ACLF) and acute variceal bleeding (AVB) is poorly understood. Specifically, the prevalence and prognosis of ACLF in the context of AVB is unclear, while the role of trans-jugular intrahepatic portosystemic shunt (TIPS) in the management in patients with ACLF has not been described to date. Methods: A multicenter, international, observational study was conducted in 2,138 patients from 34 centers between 2011 and 2015. ACLF was defined and graded according to the EASL-CLIF consortium definition. Placement of pre-emptive TIPS (pTIPS) was based on individual center policy. Patients were followed-up for 1 year, until death or liver transplantation. Cox regression and competing risk models (Gray's test) were used to identify independent predictors of rebleeding or mortality. Results: At admission, 380/2,138 (17.8%) patients had ACLF according to EASL-CLIF criteria (grade 1: 38.7%; grade 2: 39.2%; grade 3: 22.1%). The 42-day rebleeding (19% vs. 10%; p<0.001) and mortality (47% vs. 10%; p<0.001) rates were higher in patients with ACLF and increased with ACLF grades. Of note, the presence of ACLF was independently associated with rebleeding and mortality. pTIPS placement improved survival in patients with ACLF at 42 days and 1 year. This effect was also observed in propensity score matching analysis of 66 patients with ACLF, of whom 44 received pTIPs and 22 did not. Conclusions: This large multicenter international real-life study identified ACLF at admission as an independent predictor of rebleeding and mortality inpatients with AVB. Moreover, pTIPS was associated with improved survival in patients with ACLF and AVB. Lay summary: Acute variceal bleeding is a deadly complication of liver cirrhosis that results from severe portal hypertension. This study demonstrates that the presence of acute-on-chronic liver failure (ACLF) is the strongest predictor of mortality in patients with acute variceal bleeding. Importantly, patients with ACLF and acute variceal (re)bleeding benefit from pre-emptive (early) placement of a transjugular intrahepatic portosystemic shunt. (C) 2020 European Association for the Study of the Liver. Published by Elsevier B.V.es
dc.formatapplication/pdfes
dc.format.extent11 pág.es
dc.language.isoenges
dc.publisherElsevieres
dc.relation.ispartofJournal of Hepatology, 73 (5), 1082-1091.
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 Internacional*
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/*
dc.subjectAcute variceal bleedinges
dc.subjectAcute-on-chronic liver failurees
dc.subjectCirrhosises
dc.subjectRebleedinges
dc.titleRebleeding and mortality risk are increased by ACLF but reduced by pre-emptive TIPSes
dc.typeinfo:eu-repo/semantics/articlees
dcterms.identifierhttps://ror.org/03yxnpp24
dc.type.versioninfo:eu-repo/semantics/publishedVersiones
dc.rights.accessRightsinfo:eu-repo/semantics/openAccesses
dc.contributor.affiliationUniversidad de Sevilla. Departamento de Medicinaes
dc.relation.projectIDBEX 5960/13-4es
dc.relation.projectID201906230332es
dc.relation.projectIDSFB TRR57es
dc.relation.projectID5/19es
dc.relation.projectID668031; 825694; 731875es
dc.relation.projectID668031; 825694; 731875es
dc.relation.projectIDPI14/00182; PI18/01901es
dc.relation.projectIDSAF -2016 -75767 -Res
dc.relation.publisherversionhttps://www.sciencedirect.com/science/article/pii/S0168827820302361?via%3Dihubes
dc.identifier.doi10.1016/j.jhep.2020.04.024es
dc.journaltitleJournal of Hepatologyes
dc.publication.volumen73es
dc.publication.issue5es
dc.publication.initialPage1082es
dc.publication.endPage1091es
dc.contributor.funderCAPES Foundation, Ministry of Education of Brazil, Brasilia, Braziles
dc.contributor.funderCellex Foundation (PREDICT)es
dc.contributor.funderChina Scholarships Counciles
dc.contributor.funderDeutsche Forschungsgemeinschaftes
dc.contributor.funderErnst und Berta Grimmke Stiftunges
dc.contributor.funderEuropean Uniones
dc.contributor.funderInstituto de Salud Carlos IIIes
dc.contributor.funderMinisterio de Educacion y Cienciaes
dc.contributor.funderRio Hortega Fellowship grant form Instituto de Salud Carlos IIIes

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