Risk Stratification Based on Acute-on-chronic liver failure in cirrhotic patients hospitalized with acute variceal bleeding

Abstract Background and aims: Acute variceal bleeding (AVB) is a life-threatening complication of cirrhosis. This study aimed to evaluate the role of Acute-on-chronic liver failure (ACLF) in the risk stratification of cirrhotic patients hospitalized with AVB. Methods: Prospective data of 417 consecutive cirrhotic patients hospitalized with AVB were retrospectively collected and analyzed. ACLF was defined by European Association for the Study of Liver-Chronic Liver Failure Consortium (EASL-CLIF-C) and diagnosed/graded with chronic liver failure-organ failure score. Results: A total of 218 (52.2%) patients were diagnosed with EASL-ACLF (grade 1: 18.3%, grade 2: 32.2%, grade 3: 49.5%) at admission. The cumulative 6-week survival rate in patients with ACLF was significantly lower than those without (53.2% vs. 88.9%, P<0.001) and decreased in line with the severity of ACLF (P <0.001). In multivariate analysis, presence of ACLF remained as an independent risk factor for 6-week mortality after adjusting for confounding factors (HR =2.74, p<0.001). CLIF-C ACLF and CLIF-C AD outperformed traditional prognosis scores in the prediction of 6-week mortality in patients with and without ACLF, respectively. Conclusion: ACLF at admission is an independent predictor for the 6-week mortality in cirrhotic patients with AVB. For AVB patients with and without ACLF, CLIF-C ACLF and CLIF-C AD outperformed other prognostic scores in the prediction of 6-week mortality, respectively.