Long-term Clinical Course of Decompensated Alcoholic Cirrhosis

Álvarez, Marco Antonio Santamaría; Cirera, Isabel; Solá, Ricard; Bargalló, Ana; Morillas, Rosa María; Planas, Ramón

doi:10.1097/mcg.0b013e3182284e13

Cited by 69 publications

(70 citation statements)

References 36 publications

(39 reference statements)

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“…The occurrence of multiple complications even further increases the morbidity in the affected patients. These findings are consistent with results of a study by Alvarez et al which found ascites to be the commonest decompensation and 46% patients presented more than one hepatic decompensation at admission 16 . Similarly Almani et al reported that ascites was the commonest complication occurring in 59% of patients with cirrhosis in Pakistan followed by hematemesis in 27% and hepatic encephalopathy in 9% 17 .…”

Section: Discussionsupporting

confidence: 83%

Decompensated cirrhosis-related admissions in a large urban hospital in Uganda: prevalence, clinical and laboratory features and implications for planning patient management

Apica¹,

Ocama²,

Seremba³

et al. 2014

Afr H. Sci.

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Background: Cirrhosis-related complications are a major cause of morbidity and mortality in areas where its risk factors are endemic. Objective: We determined the prevalence of decompensated cirrhosis among patients on the gastroenterology service of Mulago Hospital and described the clinical and laboratory features of these patients. Methods: All patients admitted to the unit were assessed and their diagnosis documented. Patients with cirrhosis had clinical features of decompensation recorded. History of alcohol consumption was taken and testing for hepatitis B surface antigen (HBsAg) and hepatitis C antibody (anti-HCV) performed. Results: Between September 2010 and January 2011, we enrolled 482 patients. The majority (53.7%) were male, overall median age 38 years. Decompensated cirrhosis was diagnosed in 85 (17.6%) patients. Of the 85 patients, 47 (55.3%) gave a history of alcohol intake, HBsAg was positive in 23 (27.1%) and anti-HCV in 3 (3.5%). Decompensation was defined by ascites among 81 (95.3%) patients, variceal bleeding in 31 (36.5%), encephalopathy in 20 (23.5%). Conclusion: Cirrhosis is common in Mulago hospital presenting mainly with ascites and variceal bleeding. Aside from controlling causes of liver diseases, especially alcohol and hepatitis B virus infection, in the interim it is necessary to manage complications in patients who already have cirrhosis. African Health Sciences 2013; 13(4): 927 -932 http://dx

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Section: Discussionsupporting

confidence: 83%

Decompensated cirrhosis-related admissions in a large urban hospital in Uganda: prevalence, clinical and laboratory features and implications for planning patient management

Apica¹,

Ocama²,

Seremba³

et al. 2014

Afr H. Sci.

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“…Kuper et al [86] reported a relative risk of HCC of 2.4 for alcoholism alone and 22.4 for alcoholic cirrhosis compared to the general population. Several other studies also reported increased HCC risk in cirrhotic patients with alcohol as primary cause [87][88][89][90][91] . In a case-control study, heavy alcohol consumption contributed to a significant part of the 115 included HCC cases (32%), independent of other known risk factors [92] .…”

Section: Hcc Incidence In Cirrhotic Patientsmentioning

confidence: 93%

Surveillance for hepatocellular carcinoma in chronic liver disease: Evidence and controversies

Meer¹

2013

WJG

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Primary liver cancer is the sixth most common cancer in the world and the third cause of cancer-related death. Hepatocellular carcinoma (HCC) represents more than 90% of primary liver cancers and generally occurs in patients with underlying chronic liver disease such as viral hepatitis, hemochromatosis, primary biliary cirrhosis and non-alcoholic steatohepatitis. Especially cirrhotic patients are at risk of HCC and regular surveillance could enable early detection and therapy, with potentially improved outcome. We here summarize existing evidence for surveillance including ultrasound, other radiological modalities and various serum biomarkers, and current international guideline recommendations for surveillance. Ultrasound and α-fetoprotein (alone or in combination) are most frequently used for surveillance, but their sensitivities and specificities are still far from perfect, and evidence for surveillance remains weak and controversial. Various other potential surveillance tools have been tested, including serum markers as des-carboxyprothrombin, lectin-bound α-fetoprotein, and (most recently) circulating TIE2-expressing monocytes, and radiological investigations such as computed tomography-scan or magnetic resonance imaging-scan. Although early results appear promising, these tools have generally been tested in diagnostic rather than surveillance setting, and in most cases, no detailed information is available on their cost-effectiveness. For the near future, it remains important to define those patients with highest risk of HCC and most benefit from surveillance, and to restrict surveillance to these categories.

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“…The model used for ALD (Figure 1B) is based on earlier work on fibrosis progression in heavy drinkers[21-24]. ALD individuals are annually tested for LF and those obtaining an F ≥ 2 result receive detoxification therapy.…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of enhanced liver fibrosis test to assess liver fibrosis in chronic hepatitis C virus and alcoholic liver disease patients

Soto

Sampietro-Colom

Lasalvia

et al. 2017

WJG

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AIMTo assess liver fibrosis (LF) in hepatitis C virus (HCV) and alcoholic liver disease (ALD), estimate health outcomes and costs of new noninvasive testing strategiesMETHODSA Markov model was developed to simulate LF progression in HCV and ALD for a cohort of 40-year-old men with abnormal levels of transaminases. Three different testing alternatives were studied: a single liver biopsy; annual Enhanced liver fibrosis (ELF™) followed by liver stiffness measurement (LSM) imaging as a confirmation test if the ELF test is positive; and annual ELF test without LSM. The analysis was performed from the perspective of a university hospital in Spain. Clinical data were obtained from published literature. Costs were sourced from administrative databases of the hospital. Deterministic and probabilistic sensitivity analyses were performed.RESULTSIn HCV patients, annual sequential ELF test/LSM and annual ELF test alone prevented respectively 12.9 and 13.3 liver fibrosis-related deaths per 100 persons tested, compared to biopsy. The incremental cost-effectiveness ratios (ICERs) were respectively €13400 and €11500 per quality-adjusted life year (QALY). In ALD, fibrosis-related deaths decreased by 11.7 and 22.1 per 100 persons tested respectively with sequential ELF test/LSM and annual ELF test alone. ICERs were €280 and €190 per QALY, respectively.CONCLUSIONThe use of the ELF test with or without a confirmation LSM are cost-effective options compared to a single liver biopsy for testing liver fibrosis in HCV and ALD patients in Spain.

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Long-term Clinical Course of Decompensated Alcoholic Cirrhosis

Cited by 69 publications

References 36 publications

Decompensated cirrhosis-related admissions in a large urban hospital in Uganda: prevalence, clinical and laboratory features and implications for planning patient management

Decompensated cirrhosis-related admissions in a large urban hospital in Uganda: prevalence, clinical and laboratory features and implications for planning patient management

Surveillance for hepatocellular carcinoma in chronic liver disease: Evidence and controversies

Cost-effectiveness of enhanced liver fibrosis test to assess liver fibrosis in chronic hepatitis C virus and alcoholic liver disease patients

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