Incidence, risk factors and clinical prognosis of upper gastrointestinal hemorrhage in patients with acute-on-chronic liver failure

Abstract

Abstract: Objective To analyze the incidence, risk factors and clinical outcome of upper gastrointestinal bleeding (UGH) in patients with acute-on-chronic liver failure (ACLF), so as to understand the mechanism of the disease and provide guidance for early clinical intervention.Methods From February 2016 to February 2021, there were 312 patients with ACLF (190 males and 122 females) were enrolled in this study with an average age of (54.1±11.0) years. According to the appearance of UGH, they were divided into UGH group (n=117, 37.5%) and non-UGH group (n=195). UGH is defined as hematemesis, black stool or UGH observed under electronic gastroscope. T-test and Chi-square test was used for statistical comparison according to the types of data; Multivariate analysis was applied to explore the independent risk factors of UGH in ACLF patients. The survival rate was compared by Log-Rank test.Results Fifty-two cases (44.4%) in UGH group and 14 cases (7.2%) in non-UGH group has previous UGH history (P<0.05). Twelve cases (10.2%) in UGH group and 5 cases (2.6%) in non-UGH group had infection (P<0.05). Fifty-six cases (47.8%) in UGH group and 47 cases (24.1%) in non-UGH group had ascites (P<0.05). Six cases (5.1%) in UGH group and 7 cases (3.6%) in non-UGH group had hepatic encephalopathy (P<0.05). The MELD scores of UGH group and non-UGH group were (19.0±6.5) points and (11.6±5.3) points, respectively, with statistically significant difference (P<0.05). The levels of hemoglobin (Hb), total bilirubin (TBil), alanine aminotransferase (ALT), Aspartate aminotransferase (AST), international normalized ratio (INR) and serum sodium in UGH group were (84.8±13.4) g/L, (52.3±9.8) μmol/L, (82.5±17.0) U/L, (73.3±15.2) U/L, (1.4±0.2) and (132.2±6.6) mmol/L, respectively, which were significantly different when compared with those of [(106.4±16.1) g/L, (24.5±5.6) μmol/L, (58.4±11.6) U/L, (46.2±8.9) U/L, (1.0±0.2) and (140.6±7.6) mmol/L, respectively, in non-UGH group (P<0.05). The above-mentioned difference data were then taken as independent variables for multivariate analysis for the risk factors of UGH in ACLF patients. The Results suggested that previous UGH history, MELD score and INR were independent predictors of bleeding in HBV-ACLF patients (P<0.05). All patients were followed up for 3 months, and the endpoint was ACLF-related death. The 28-day and 90-day survival rates of UGH group (66.7% and 40.2%) were significantly lower than those of non-UGH group (87.7% and 77.9%) (all P<0.05).Conclusion The clinical prognosis of ACLF patients complicated with UGH is poor. In clinical practice, attention should be paid to patient’s with past UGH history and poor coagulation state. Early clinical intervention should be taken to avoid the occurrence of UGH.

Key words: Acute-on-chronic liver failure, Upper gastrointestinal hemorrhage, Multivariate analysis

ZHANG Xia, ZHAO Zi-yu, LI Min. Incidence, risk factors and clinical prognosis of upper gastrointestinal hemorrhage in patients with acute-on-chronic liver failure[J]. Chinese Hepatolgy, 2022, 27(6): 672-674.

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