Rebleeding and mortality risk are increased by ACLF but reduced by pre-emptive TIPS

•Variceal bleeding is frequently associated with ACLF in cirrhosis.•ACLF is independently associated with rebleeding and mortality.•Patients with variceal bleeding and ACLF can benefit from a pre-emptive (early) TIPS. Background & AimsThe relationship between acute-on-chronic liver failure (ACLF) and acute variceal bleeding (AVB) is poorly understood. Specifically, the prevalence and prognosis of ACLF in the context of AVB is unclear, while the...