Prior Decompensation Identifies Patients at High Mortality Risk Despite Standard Therapy After Variceal Hemorrhage: An Individual Patient Data Meta-Analysis.
Laura Turco, Vincenzo La Mura, Pol Olivas et al.
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In 30 seconds
This systematic review and individual participant data meta-analysis examined whether decompensation before variceal hemorrhage was associated with outcomes in patients with Child-Pugh A-B cirrhosis receiving nonselective beta-blockers plus endoscopic variceal ligation, without pre-emptive TIPS. Across 13 studies and 1,659 patients, two-year mortality was 25.1% among those with prior decompensation and 13.5% among those without (P < .0001). Prior decompensation was associated with higher adjusted mortality (pooled hazard ratio, 1.4; 95% confidence interval, 1.1-1.7) and new or worsening decompensation (1.7; 95% confidence interval, 1.15-2.44).
Key findings
- Two-year mortality was 25.1% with prior decompensation versus 13.5% without (P < .0001).
- Prior decompensation was associated with higher adjusted mortality: pooled hazard ratio, 1.4 (95% confidence interval, 1.1-1.7).
- New or worsening decompensation was more frequent with prior decompensation: pooled adjusted hazard ratio, 1.7 (95% confidence interval, 1.15-2.44).
Why it matters
The findings indicate that patients with prior decompensation remain at elevated risk despite standard secondary prevention after variceal hemorrhage. Recognising this risk may help frame prognosis and identify a subgroup for whom alternative strategies merit study, while the analysis does not establish that changing treatment improves outcomes.
What to keep in mind
The analysis combined randomized and observational studies; the reported associations do not establish that prior decompensation causes worse outcomes or that another treatment would reduce risk.