{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T08:12:57Z","timestamp":1769501577277,"version":"3.49.0"},"reference-count":48,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2021,1,23]],"date-time":"2021-01-23T00:00:00Z","timestamp":1611360000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2021,1,23]],"date-time":"2021-01-23T00:00:00Z","timestamp":1611360000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:sec>\n            <jats:title>Background and Aims<\/jats:title>\n            <jats:p>Optimal candidates for early transjugular intrahepatic portosystemic shunt (TIPS) in patients with Child\u2010Pugh 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\u2010C 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\u2010Pugh B cirrhosis and AVB.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Approach and Results<\/jats:title>\n            <jats:p>We analyzed the pooled individual data from two previous studies of 608 patients with Child\u2010Pugh B cirrhosis and AVB who received standard treatment between 2010 and 2017 in China. The concordance index values of CLIF\u2010C ADs for 6\u2010week and 1\u2010year mortality (0.715 and 0.708) were significantly better than those of active bleeding at endoscopy (0.633 [<jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.001] and 0.556 [<jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.001]) and other prognostic models. With X\u2010tile software identifying an optimal cutoff value, patients were categorized as low risk (CLIF\u2010C ADs &lt;48), intermediate risk (CLIF\u2010C ADs 48\u201056), and high risk (CLIF\u2010C ADs &gt;56), with a 5.6%, 16.8%, and 25.4% risk of 6\u2010week death, respectively. Nevertheless, the performance of CLIF\u2010C ADs for predicting a composite endpoint of 6\u2010week death or further bleeding was not satisfactory (area under the receiver operating characteristics curve [AUC], 0.588). A nomogram incorporating components of CLIF\u2010C ADs and albumin, platelet, active bleeding, and ascites significantly improved the prediction accuracy (AUC, 0.725).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>In patients with Child\u2010Pugh B cirrhosis and AVB, risk stratification using CLIF\u2010C ADs identifies a subgroup with high risk of death that may derive survival benefit from early TIPS. With improved prediction accuracy for 6\u2010week death or further bleeding, the data\u2010driven nomogram may help to stratify patients in randomized trials. Future external validation of these findings in patients with different etiologies is required.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1002\/hep.31478","type":"journal-article","created":{"date-parts":[[2020,7,24]],"date-time":"2020-07-24T16:41:09Z","timestamp":1595608869000},"page":"1478-1493","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":35,"title":["Risk Stratification Based on Chronic Liver Failure Consortium Acute Decompensation Score in Patients With Child\u2010Pugh B Cirrhosis and Acute Variceal Bleeding"],"prefix":"10.1097","volume":"73","author":[{"given":"Yong","family":"Lv","sequence":"first","affiliation":[{"name":"Department of Liver Diseases and Digestive Interventional Radiology,National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases,Fourth Military Medical University,Xi\u2019an,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhengyu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Liver Diseases and Digestive Interventional Radiology,National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases,Fourth Military Medical University,Xi\u2019an,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kai","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Liver Diseases and Digestive Interventional Radiology,National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases,Fourth Military Medical University,Xi\u2019an,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qiuhe","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Liver Diseases and Digestive Interventional Radiology,National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases,Fourth Military Medical University,Xi\u2019an,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Bai","sequence":"additional","affiliation":[{"name":"Department of Liver Diseases and Digestive Interventional Radiology,National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases,Fourth Military Medical University,Xi\u2019an,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xulong","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Liver Diseases and Digestive Interventional Radiology,National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases,Fourth Military Medical University,Xi\u2019an,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tianlei","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Liver Diseases and Digestive Interventional Radiology,National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases,Fourth Military Medical University,Xi\u2019an,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing","family":"Niu","sequence":"additional","affiliation":[{"name":"Department of Liver Diseases and Digestive Interventional Radiology,National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases,Fourth Military Medical University,Xi\u2019an,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhiping","family":"Yang","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Cancer Biology,National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases,Fourth Military Medical University,Xi\u2019an,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuan","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology,First Affiliated Hospital of Nanchang University,Nanchang,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianbo","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology,Nanfang Hospital,Southern Medical University,Guangzhou,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui","family":"Xue","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology,First Affiliated Hospital of Xi'an Jiaotong University,Xi'an,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zaibo","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of interventional Radiology,Third Affiliated Hospital of Sun Yat\u2010sen University,Guangzhou,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuzheng","family":"Zhuge","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology,Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chunqing","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology,Shandong Provincial Hospital affiliated to Shandong University,Jinan,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junhui","family":"Sun","sequence":"additional","affiliation":[{"name":"Hepatobiliaryand Pancreatic Intervention Center,Division of Hepatobiliary and Pancreatic Surgery,First Affiliated Hospital,School of Medicine,Zhejiang University,Hangzhou,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pengxu","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery,First Affiliated Hospital of Zhengzhou University,Zhengzhou,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weixin","family":"Ren","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology,First Affiliated Hospital of Xinjiang Medical University,Urumqi,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yingchun","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology,Second Affiliated Hospital of Kunming Medical University,Kunming,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kewei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery,Henan Provincial People's Hospital,Zhengzhou,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenguang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology,First Affiliated Hospital of Zhengzhou University,Zhengzhou,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wengang","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Liver Diseases and Digestive Interventional Radiology,National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases,Fourth Military Medical University,Xi\u2019an,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bohan","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Liver Diseases and Digestive Interventional Radiology,National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases,Fourth Military Medical University,Xi\u2019an,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaomei","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Liver Diseases and Digestive Interventional Radiology,National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases,Fourth Military Medical University,Xi\u2019an,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jie","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Liver Diseases and Digestive Interventional Radiology,National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases,Fourth Military Medical University,Xi\u2019an,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Na","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Liver Diseases and Digestive Interventional Radiology,National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases,Fourth Military Medical University,Xi\u2019an,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Liver Diseases and Digestive Interventional Radiology,National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases,Fourth Military Medical University,Xi\u2019an,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chuangye","family":"He","sequence":"additional","affiliation":[{"name":"Department of Liver Diseases and Digestive Interventional Radiology,National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases,Fourth Military Medical University,Xi\u2019an,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhanxin","family":"Yin","sequence":"additional","affiliation":[{"name":"Department of Liver Diseases and Digestive Interventional Radiology,National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases,Fourth Military Medical University,Xi\u2019an,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daiming","family":"Fan","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Cancer Biology,National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases,Fourth Military Medical University,Xi\u2019an,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4568-3776","authenticated-orcid":false,"given":"Guohong","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Liver Diseases and Digestive Interventional Radiology,National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases,Fourth Military Medical 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