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Objective To investigate the risk factors for acute variceal bleeding(AVB) in acute-on-chronic liver failure(ACLF) and its influence on prognosis. Methods A total of 1409 ACLF patients who were admitted to The Fifth Medical Center of Chinese PLA General Hospital from 2009 to 2015 were followed up for 6 months, and according to the presence or absence of AVB, they were divided into AVB group and non-AVB group. The Student’s t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups. The Kaplan-Meier curves were plotted and the Log-rank test was performed to analyze mortality rate and progression during follow-up, and a binary Logistic regression analysis was used to investigate the risk factors for AVB. Results Among these 1409 patients, 167(11.85%) experienced AVB. The 30-day survival rate was 43.42% in the AVB group and 67.79% in the non-AVB group(χ~2=33.558, P<0.001), and the 180-day survival rate was 18.91% in the AVB group and 53.97% in the non-AVB group(χ~2=76.881, P<0.001). The Log-rank test showed significant differences in 30-and 180-day survival rates between the AVB group and the non-AVB group(χ~2=40.950 and 89.320, both P<0.05). The Logistic regression analysis showed that pleural effusion(odds ratio [OR]=1.522, 95% confidence interval [CI]: 1.071-2.162, P=0.019), acute kidney injury(AKI)(OR=2.201, 95%CI: 1.415-3.426, P<0.001), ABC subtype of ACLF(OR=2.491, 95%CI: 1.489-4.168, P=0.001), ACLF stage(OR=2.403, 95%CI: 1.687-3.421, P<0.001), and urea(OR=2.567,95%CI: 1.570-4.196,P<0.001)were independently associated with AVB in ACLF patients. Conclusion AVB is an important influencing factor for the short-term survival of ACLF patients, and pleural effusion, AKI, BC subtype of ACLF, advanced ACLF, and urea are independent risk factors for the onset of AVB. [ABSTRACT FROM AUTHOR]

The heme oxygenase,as a rate limiting enzyme in the process of heme degradation,plays an important role in antioxidant,anti-inflammatory,inhibiting cell apoptosis and improving tissue microcirculation together with the hydrolysates of bilirubin,CO.Heme oxygenase 1,an inducible heme oxygenase,can be adaptively induced and cytoprotective in septicopyemia,hypertension,acute lung injury and other diseases.The cytoprotective effect of heme oxygenase 1 can also be seen in the hepatic ischemia reperfusion injury,liver cirrhosis,hepatic failure,liver transplantation,acute kidney injury as well as renal allograft injury.The recent development of the role of heme oxygenase 1 in liver and kidney disease is reviewed in order to discuss the possible new breakthrough for future therapies. [ABSTRACT FROM AUTHOR]

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