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- W4226201440 abstract "Background: In patients with cirrhosis presenting with acute variceal bleeding(AVB) as an index event, stratification for future risks of acute decompensation(AD) beyond the assessment of MELD score and HVPG is currently limited. Aim: To assess if liver stiffness measurement(LSM) during AVB could be used to predict future AD events more accurately in these patients. Methods: In this prospective study, LSM was assessed on day-2 during AVB in patients with cirrhosis as index presentation without previous/current other decompensations. The performance characteristics of post-bleed LSM was compared with MELD score, active bleeding and HVPG to assess the cumulative rates of AD at 3 months. In addition, to ascertain the effect of AVB as a decompensation event, the rates of AD in patients with AVB were compared with a cohort of compensated cirrhosis(CC) with similar LSM selected using propensity score matching (PSM). Results: Patients with Child-A cirrhosis(n=109) presenting with AVB as an index event(mean age:44±11 years, 80% males) of alcoholic liver disease(50%), non-alcoholic steatohepatitis (21.1%), viral cirrhosis(11%) and other etiologies(18.3%) were included and given carvedilol for secondary prophylaxis. Over a median follow-up of 6 months(range:2-9months), 33(30.2%) patients developed AD. Post-bleed LSM had an AUROC of 0.914(0.861-0.967) for predicting future AD events, which was significantly better than MELD score[AUROC- 0.668 (0.562-0.774), P<0.001)] and HVPG(n=54)[0.733 (0.601-0.865), P=0.004]. A LSM of 47kPa had a sensitivity of 86%(69-96) and specificity of 88%(76-94) to accurately predict AD within 3 months. Despite similar LSM(62.05 ± 9.40kPa in AVB versus 58.39 ± 11.57kPa in CC; P=0.135), significantly higher proportion of patients developed AD at 3 months in patients with AVB compared to a matched cohort of CC(73.9% vs 26.5%, P<0.001). Conclusions: Post-bleed LSM can triage patients with Child-A cirrhosis with AVB regarding risk of future AD. Acute variceal bleeding triggers risks of AD in high-risk patients with elevated LSM." @default.
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- W4226201440 date "2022-01-01" @default.
- W4226201440 modified "2023-09-27" @default.
- W4226201440 title "Liver Stiffness Measurement During the Episode of Acute Variceal Bleeding Accurately Predicts Risk of Future Acute Decompensation Events in Patients with Child-A Cirrhosis: A Prospective Proof of Concept Study" @default.
- W4226201440 doi "https://doi.org/10.1016/j.jceh.2021.10.023" @default.
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