Multicenter External Validation of Risk Stratification Criteria for Patients With Variceal Bleeding

Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association
Irene ConejoSalvador Augustin

Abstract

Early placement of a transjugular intrahepatic portosystemic shunts (TIPS) is considered the treatment of choice for patients with acute variceal bleeding (AVB) and cirrhosis who have a high risk of death (Child-Pugh class B with active bleeding at endoscopy or Child-Pugh class C). It has been proposed that patients of Child-Pugh class B, even with active bleeding, should not be considered high risk. Alternative criteria have been proposed for identification of high-risk patients, such as Child-Pugh class C with plasma level of creatinine of 1 mg/dL or more (ChildC-C1) and a model for end-stage liver disease (MELD) score of 19 or more. We analyzed outcomes of a large cohort of patients with AVB who received the standard of care at different centers to validate these systems of risk stratification. We performed an observational study of 915 patients with liver cirrhosis and AVB who received standard treatment (drugs, antibiotics, and endoscopic ligation, with TIPS as the rescue treatment), over different time periods between 2006 and 2014 in Canada and Europe. All patients were followed until day 42 (week 6) after index AVB or death. Child-Pugh and MELD scores were calculated at time of hospital admission. The primary outcome wa...Continue Reading

Citations

Mar 27, 2019·BMJ : British Medical Journal·Adrian J Stanley, Loren Laine
Sep 5, 2020·Alimentary Pharmacology & Therapeutics·Tehara WickremeratneJames O'Beirne
Feb 23, 2018·Liver International : Official Journal of the International Association for the Study of the Liver·Gennaro D'AmicoGiuseppe Malizia
Jul 25, 2020·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Yong LvGuohong Han
Oct 23, 2020·World Journal of Gastroenterology : WJG·Sasidharan RajeshPhilip Augustine
Mar 13, 2021·Drugs·Saleh A Alqahtani, Sunguk Jang
Mar 23, 2021·Therapeutic Advances in Chronic Disease·Charelle ManningSyed Alam
Sep 28, 2020·Gastroenterology·Oana Nicoară-FarcăuUNKNOWN Preemptive TIPS Individual Data Metanalysis, International Variceal Bleeding Study and Baveno Cooperation Study groups
Apr 12, 2021·Clinics in Liver Disease·Anna BaigesJuan Carlos García-Pagán
May 8, 2021·Journal of the American College of Radiology : JACR·UNKNOWN Expert Panels on Interventional Radiology and Vascular ImagingEric J Hohenwalter
May 11, 2021·Liver International : Official Journal of the International Association for the Study of the Liver·Arpan MohantyTarun Rustagi

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