Clinical Features and Prognosis of the Patients with Chronic Liver Disease Hospitalized with Variceal Bleeding

초록

Background and Aims: Variceal bleeding is a critical acute deterioration causes in the patient with cirrhosis. The aim of our study is to investigate the risk factor associated with mortality in the patients hospitalized with variceal bleeding and to evaluate the prognosis according to the presence of acute-on-chronic liver failure (ACLF). Method: This was a retrospective study conducted in patients from the Korean acute-on-chronic liver failure (KACLiF) study cohort, including 474 consecutive patients who were hospitalized with variceal bleeding from January 2013 to December 2013 in 21 hospitals. ACLF was defined by EASL-CLIF consortium (CLIF-C). Results: Among a total of 474 patients, 61 patients were diagnosed with ACLF according to the CLIF-C. The cumulative overall survival rates (OS) of the patients with varix bleeding at 30 and 90 days became significantly lower, according to the ACLF grade (p-value<0.001). The combination of virus and alcohol, as a cause of underlying liver disease, represented poor prognosis of the patients with varix bleeding than other causes. In multivariate variable analysis, the significant predictive factor of OS of the patients hospitalized with varix bleeding was white blood cell (Hazard ratio, HR 1.01, p =0.029), c-reactive protein (HR 1.09, p=0.013), and CLIF sequential organ failure assessment (SOFA) score (HR 1.49, p <0.001). The CLIF SOFA score also was a significant predictive factor of OS in patients with ACLF and varix bleeding (p-value<0.001). CLIF SOFA score showed the reliable area under the receiver operating characteristic curve (AUROC) for the prediction of mortality at 30 (0.895, CI 0.829-0.962) and 90 days (0.896, CI 0.842-0.951). Conclusion: In patients hospitalized with variceal bleeding, the presence of ACLF showed a poor prognosis, according to CLIF-SOFA score. Furthermore, CLIF-SOFA model represented reliable score for mortality prediction in patients with variceal bleeding.