Risk Stratification Based on Chronic Liver Failure Consortium Acute Decompensation Score in Patients With Child-Pugh B Cirrhosis and Acute Variceal Bleeding

作者：Lv, Yong; Wang, Zhengyu; Li, Kai; Wang, Qiuhe; Bai, Wei; Yuan, Xulong; Yu, Tianlei; Niu, Jing; Yang, Zhiping; Zhu, Xuan; Zhao, Jianbo; Xue, Hui; Jiang, Zaibo; Zhuge, Yuzheng; Zhang, Chunqing; Sun, Junhui; Ding, Pengxu; Ren, Weixin; Li, Yingchun; Zhang, Kewei; Zhang, Wenguang; Guo, Wengang; Luo, Bohan; Li, Xiaomei; Yuan, Jie; Han, Na; Zhu, Ying; He, Chuangye; Yin, Zhanxin; Fan, Daiming; Han, Guohong

来源：Hepatology, 2021, 73(4): 1478-1493.

DOI：10.1002/hep.31478

Background and Aims Optimal candidates for early transjugular intrahepatic portosystemic shunt (TIPS) in patients with Child-Pugh B cirrhosis and acute variceal bleeding (AVB) remain unclear. This study aimed to test the hypothesis that risk stratification using the Chronic Liver Failure Consortium Acute Decompensation score (CLIF-C ADs) may be useful to identify a subgroup at high risk of mortality or further bleeding that may benefit from early TIPS in patients with Child-Pugh B cirrhosis and AVB. @@@ Approach and Results We analyzed the pooled individual data from two previous studies of 608 patients with Child-Pugh B cirrhosis and AVB who received standard treatment between 2010 and 2017 in China. The concordance index values of CLIF-C ADs for 6-week and 1-year mortality (0.715 and 0.708) were significantly better than those of active bleeding at endoscopy (0.633 [P P < 0.001]) and other prognostic models. With X-tile software identifying an optimal cutoff value, patients were categorized as low risk (CLIF-C ADs <48), intermediate risk (CLIF-C ADs 48-56), and high risk (CLIF-C ADs >56), with a 5.6%, 16.8%, and 25.4% risk of 6-week death, respectively. Nevertheless, the performance of CLIF-C ADs for predicting a composite endpoint of 6-week death or further bleeding was not satisfactory (area under the receiver operating characteristics curve [AUC], 0.588). A nomogram incorporating components of CLIF-C ADs and albumin, platelet, active bleeding, and ascites significantly improved the prediction accuracy (AUC, 0.725). @@@ Conclusions In patients with Child-Pugh B cirrhosis and AVB, risk stratification using CLIF-C ADs identifies a subgroup with high risk of death that may derive survival benefit from early TIPS. With improved prediction accuracy for 6-week death or further bleeding, the data-driven nomogram may help to stratify patients in randomized trials. Future external validation of these findings in patients with different etiologies is required.

• 单位
  郑州大学; 1; 南方医科大学; 西安交通大学; 中国人民解放军第四军医大学; 南昌大学; 山东大学; 中山大学; 浙江大学; 南京大学