Wong Yu Jun, Buckholz Adam, Sim Alyssa, Teng Margaret, Wong Rochelle, Curry Michael P, De Roza Marianne Anastasia, Baffy Gyorgy, Teoh Xuhui, Chak Eric, Rustagi Tarun, Chang Jason, Wong Guan Wee, Tandon Puneeta, Garcia-Tsao Guadalupe, Abraldes Juan G, Mohanty Arpan, Fortune Brett
Department of Gastroenterology & Hepatology, Changi General Hospital, Singapore; Liver Unit, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada.
Division of Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York.
Clin Gastroenterol Hepatol. 2025 Sep;23(10):1776-1785.e10. doi: 10.1016/j.cgh.2024.10.022. Epub 2024 Dec 14.
BACKGROUND & AIMS: Acute variceal bleeding (AVB) portends significant 6-week mortality in patients with cirrhosis. It remains unclear if the correlation between liver prognostic scores and 6-week mortality are similar across different etiologies of liver cirrhosis, particularly alcohol-related liver disease (ALD) vs non-alcohol-related liver disease (non-ALD). This study aims to compare the 6-week mortality following AVB in these 2 patient populations.
We assessed outcomes after AVB in 2 large multicenter cohorts from the United States and Singapore of patients with cirrhosis presenting with AVB. Using multivariable logistic regression, 6-week mortality between ALD and non-ALD cirrhosis was compared. Sensitivity analyses were performed with propensity-score matching analyses of the overall cohort.
A total of 1349 patients with AVB from the United States (n = 469) and Singapore (n = 880) cohorts were included. The aggregated cohort consisted of 379 patients (27.5%) with ALD cirrhosis. The overall 6-week mortality was 14.4%. Non-ALD cirrhosis was associated with a significantly higher 6-week mortality than ALD cirrhosis after accounting for Child-Turcotte-Pugh (CTP) score (adjusted odds ratio [aOR], 2.9; 95% confidence interval [CI], 1.5-5.3), Model of End-stage Liver Disease (MELD) score (aOR, 3.0; 95% CI, 1.6-5.6), and MELD 3.0 score (aOR, 3.3; 95% CI, 1.7-6.4). Addition of cirrhosis etiology (ALD vs non-ALD) to existing prognostic scores improved the prediction of 6-week mortality following AVB (MELD 3.0 c-statistic: 0.784 vs 0.770; P < .001). An etiology-adjusted updated MELD 3.0 model was the best prediction model for 6-week mortality after AVB.
Patients with non-ALD cirrhosis presenting with AVB had a higher risk of 6-week mortality, at each severity of liver disease by standard indices, than patients with ALD cirrhosis. Cirrhosis etiology (ALD vs non-ALD) should be incorporated into the risk stratification of patients with AVB.
急性静脉曲张出血（AVB）预示着肝硬化患者6周死亡率较高。目前尚不清楚肝硬化不同病因（尤其是酒精性肝病[ALD]与非酒精性肝病[non-ALD]）的肝脏预后评分与6周死亡率之间的相关性是否相似。本研究旨在比较这两类患者群体中AVB后的6周死亡率。
我们评估了来自美国和新加坡的2个大型多中心队列中肝硬化并出现AVB患者的AVB后结局。使用多变量逻辑回归比较了ALD和非ALD肝硬化患者的6周死亡率。对整个队列进行倾向评分匹配分析以进行敏感性分析。
总共纳入了来自美国队列（n = 469）和新加坡队列（n = 880）的1349例AVB患者。汇总队列包括379例（27.5%）ALD肝硬化患者。总体6周死亡率为14.4%。在考虑Child-Turcotte-Pugh（CTP）评分（校正比值比[aOR]，2.9；95%置信区间[CI]，1.5 - 5.3）、终末期肝病模型（MELD）评分（aOR，3.0；95% CI，1.6 - 5.6）和MELD 3.0评分（aOR，3.3；95% CI，1.7 - 6.4）后，非ALD肝硬化与6周死亡率显著高于ALD肝硬化相关。将肝硬化病因（ALD与非ALD）添加到现有预后评分中可改善对AVB后6周死亡率的预测（MELD 3.0 c统计量：0.784对0.770；P <.001）。病因校正后的更新MELD 3.0模型是AVB后6周死亡率的最佳预测模型。
与ALD肝硬化患者相比，出现AVB的非ALD肝硬化患者在每种标准指标定义的肝病严重程度下，6周死亡风险更高。肝硬化病因（ALD与非ALD）应纳入AVB患者的风险分层。
