317 Prognostic Indicators of Survival in Compensated and Decompensated Stages of Liver Cirrhosis: Validation of a 4-Stage Classification

Zipprich, Alexander; Dollinger, MM; Garcia-Tsao, G.; Rogowski, Sebastian

doi:10.1016/s0168-8278(08)60319-0

Cited by 4 publications

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“…Probably the higher proportion of persistent drinkers among patients with complications contributed to this association. Mortality among patients with variceal bleeding has previously been found to be similar in those with and without a history of ascites,28 but our results and those from a recent German study demonstrate that this is not the case 29. A likely explanation for the emerging importance of ascites among patients with variceal bleeding is that bleeding is less fatal now than it was in the past 30.…”

Section: Discussioncontrasting

confidence: 49%

Clinical course of alcoholic liver cirrhosis: A Danish population-based cohort study

et al. 2009

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The clinical course of alcoholic cirrhosis, a condition with a high mortality, has not been well described. We examined prevalence, risk, chronology, and mortality associated with three complications of cirrhosis: ascites, variceal bleeding, and hepatic encephalopathy. We followed a population-based cohort of 466 Danish patients diagnosed with alcoholic cirrhosis in 1993-2005, starting from the date of hospital diagnosis and ending in August 2006. Data were extracted from medical charts during the follow-up period. Risk and mortality associated with complications were calculated using competing-risks methods. At diagnosis of alcoholic cirrhosis, 24% of patients had no complications, 55% had ascites alone, 6% had variceal bleeding alone, 4% had ascites and variceal bleeding, and 11% had hepatic encephalopathy. One-year mortality was 17% among patients with no initial complications, 20% following variceal bleeding alone, 29% following ascites alone, 49% following ascites and variceal bleeding (from the onset of the later of the two complications), and 64% following hepatic encephalopathy. Five-year mortality ranged from 58% to 85%. The risk of complications was about 25% after 1 year and 50% after 5 years for all patients without hepatic encephalopathy. The complications under study did not develop in any predictable sequence. Although patients initially without complications usually developed ascites first (12% within 1 year), many developed either variceal bleeding first (6% within 1 year) or hepatic encephalopathy first (4% within 1 year). Subsequent complications occurred in an unpredictable order among patients with ascites or variceal bleeding. Conclusion: Patients with alcoholic cirrhosis had a high prevalence of complications at the time of cirrhosis diagnosis. The presence and type of complications at diagnosis were predictors of mortality, but not of the risk of subsequent complications. (HEPATOLOGY 2010;51:1675-1682

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Section: Discussioncontrasting

confidence: 49%

Clinical course of alcoholic liver cirrhosis: A Danish population-based cohort study

et al. 2009

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“…This two‐stage model of the natural history of cirrhosis has been further refined to include four stages , including compensated cirrhosis with no ascites or oesophageal varices (stage 1, 1% mortality at 1 year), compensated cirrhosis with oesophageal varices without bleeding and no ascites (stage 2, 3% mortality at 1 year), decompensated cirrhosis with ascites with or without oesophageal varices (stage 3, 20% mortality at 1 year) and decompensated cirrhosis with variceal bleeding with or without ascites (stage 4, 57% mortality at 1 year) . This model has been validated and evidence supporting this classification is reviewed elsewhere . However, the majority of the studies performed to date have only considered mortality rates stratified by the two‐stage model, with a cumulative 1 year survival of 95% in those with compensated disease when compared to 61% in those with decompensated disease .…”

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confidence: 99%