Prognostic indicators of survival in patients with compensated and decompensated cirrhosis

Abstract

Background/Aims Patients with cirrhosis are classified in a compensated and a decompensated stage. Portal hypertension is responsible for most of the complications of cirrhosis that mark the transition from compensated to decompensated cirrhosis. The objectives of this study were (a) to analyse survival of the different stages and substages of cirrhosis and (b) to examine the prognostic value of the hepatic venous pressure gradient (HVPG) at each of the stages. Methods A total of 729 patients with suspected cirrhosis underwent routine measurement of portal pressure and systemic haemodynamics between 11/1995 and 12/2004. The primary end-point of the study was death, collected until November 30th, 2006. Multivariable analysis was performed using two models to determine predictors of death at each stage. Results A total of 443 patients were included in the study. The 1-year mortality was 5.4% in compensated and 20.2% in decompensated patients. Compensated patients in stage 1 (no varices) had a longer survival than stage 2 patients (varices present) (P = 0.015). In decompensated patients, survival was not different between stage 3 (ascites, with or without varices) and stage 4 (variceal haemorrhage, with or without ascites). Age and HVPG (cut-off 10 mmHg) were independent predictors of death in compensated patients, whereas MELD was in decompensated patients. Conclusion Survival rates and predictors of death are different between patients with compensated and decompensated cirrhosis. Unlike the Italian cohort staging system, ascites is a better stratifying clinical event than variceal haemorrhage in patients with decompensated cirrhosis. The presence of clinically significant portal hyper-tension has prognostic value in compensated cirrhosis.

Understanding the Complexities of Cirrhosis

“…11 Given the difference in risk of mortality and survival rates between compensated and decompensated cirrhosis, patients and health care providers should have a clear understanding of distinctions between the 2 stages. 18,22,23 Other tools for assessing CLD severity and prognosis have been used for decades. The extent of cirrhosis is subclassified into 4 or 5 stages with varying prognoses, each defined clinically by the presence or absence of select complications ( Figure 2).…”

Constraining Effect of Mild Portal Hypertension against the Negative Influence of Muscle Mass Loss in Cirrhosis after Esophageal Variceal Eradication

“…In other words, the patient's condition suggests the presence of a certain degree of PH, evidenced by a mean HVPG of 14.9 mmHg and 75.6% patients with HVPG 12 mmHg or higher. In fact, investigators suggested that the link between the severity of PH and the prognosis of cirrhosis patients is contentious, and the influence of portal pressure may depend on the additional patient condition factors such as liver function and/or compensation/decompensation [22,23].…”

Cirrhotic Portal Hypertension: New Insights in an Old Syndrome

“…Clinically significative portal hypertension ,CSPH, defined by HVPG above 10 mmHG, is an important predictive factor of decompensation, appearance of hepatocellular carcinoma (HCC), death and also related to therapeutic response (BERZIGOTTI, 2008;ZIPPRICH;GARCIA-TSAO et al, 2012;VOROBIOFF;GROZMANN, 2015). Those patients with a GPVH between 5 mmHg and 10 mmHg, non-clinically significative portal hypertension, should have optimize ethiology treatment to avoid disease progression.…”