Non-alcohol-related cirrhosis leads to higher 6-week mortality after acute variceal bleeding than alcohol-related cirrhosis.

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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 two patient populations. We assessed outcomes after AVB in two large multi-center cohorts from the U.S. 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 propensity-score matching analyses of the overall cohort. A total of 1,349 AVB patients from the U.S. (n=469) and Singapore (n=880) cohorts were included. The aggregated cohort consisted of 379 (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 CTP (aOR: 2.9, 95%CI: 1.5-5.3), MELD (aOR: 3.0, 95%CI: 1.6-5.6) and MELD 3.0 (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<0.001). An etiology-adjusted updated MELD 3.0 model was the best prediction model for 6-week mortality after AVB. 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 versus non-ALD) should be incorporated into the risk stratification of AVB patients.