Published in:
01-09-2020 | Hepatic Encephalopathy | Original Article
Acute-on-Chronic Liver Failure in Budd–Chiari Syndrome: Profile and Predictors of Outcome
Authors:
Shalimar, Sanchit Sharma, Shivanand R. Gamanagatti, Ashish Chauhan, Sudheer Kumar Vuyyuru, Anshuman Elhence, Gyanranjan Rout, Anoop Saraya, Deepak Gunjan, Baibaswata Nayak, Ramesh Kumar, Subrat Kumar Acharya
Published in:
Digestive Diseases and Sciences
|
Issue 9/2020
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Abstract
Background and Aim
There is a paucity of data on the clinical presentations and outcome of Budd–Chiari syndrome (BCS) patients presenting as acute-on-chronic liver failure (BCS-ACLF). We aimed to describe the profile and outcomes of endovascular interventions in patients with BCS-ACLF.
Methods
All BCS-ACLF patients presenting between October 2007 and April 2019 satisfying the Asian Pacific Association for the Study of the Liver (APASL) definition were studied. We compared 30- , 90- and, 180-day survival among BCS-ACLF patients who underwent endovascular intervention with those who did not, and with a historical cohort of Child-C BCS patients without ACLF who underwent endovascular intervention.
Results
Twenty-eight (5%) of 553 BCS patients presented as ACLF as per APASL definition. The majority (60.7%) were males, and mean age was 29.6 ± 11.2 years. The most common site of the block was isolated involvement of hepatic veins-HV (68%), followed by combined inferior vena cava (IVC) and HV block (25%) and isolated IVC block (7%). The acute precipitants were stent thrombosis (17.9%), acute HV thrombosis (10.7%), acute viral hepatitis (7.1%), and antituberculosis drug with hepatitis B virus reactivation (3.6%). In 60.7% patients, no acute precipitant could be identified. The 30- , 90- , and 180-day survival in BCS-ACLF post-endovascular intervention (n = 15), BCS-ACLF without endovascular intervention (n = 13), and Child-C BCS without ACLF who underwent endovascular intervention (n = 25) were (93%, 87%, and 87%), (46%, 28%, and 0%) and (96%, 92%, and 88%), respectively (log-rank test, p value < 0.001). On multivariate Cox proportional analysis, endovascular intervention and the presence of hepatic encephalopathy were independent predictors of mortality.
Conclusion
Budd–Chiari syndrome can present as acute-on-chronic liver failure. Endovascular intervention is associated with an improved outcome.