Nonalcohol-related Cirrhosis Leads to Higher 6-week Mortality After Acute Variceal Bleeding Than Alcohol-related Cirrhosis

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. Methods: 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. Results: 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. Conclusion: 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.