Survival and prognostic indicators in compensated and decompensated cirrhosis

Abstract

Six-year survival of cirrhosis was assessed in a series of 1155 consecutive patients (751 men, 404 women). Among the men, 33% were alcoholics and 18% were HBsAg positive; corresponding figures for the women were 15% and 6% respectively. Features of decompensation at first presentation were observed in 63% of the patients. Six-year survival was 54% in compensated and 21% in decompensated patients. No significant differences in survival were found between alcoholics and nonalcoholics. Leading causes of death were liver failure (49%), hepatocellular carcinoma (22%), and bleeding (13%). The prognostic role of 21 variables was evaluated separately in compensated and decompensated patients by the Cox's regression model. The following variables were found to be significant predictors of death risk in compensated patients: male sex, HBsAg positivity, age, prothrombin time prolongation, and esophageal varices. In decompensated disease the significant indicators of death risk were: hepatocellular carcinoma, encephalopathy, hemorrhage, SGOT, esophageal varices, gamma globulins, prothrombin time prolongation, continued abuse of alcohol, HBsAg positivity, gamma glutamyl transpeptidase, and cholinesterase. A simple prognostic index based upon the relative risk coefficient of the significant variables is suggested.

Management of adult patients with ascites caused by cirrhosis

“…6 Liver transplantation should be considered in the treatment options for these patients, especially when local waiting times exceed 12 months. …”

“…5 The development of fluid retention in the setting of cirrhosis is an important landmark in the natural history of chronic liver disease. Approximately 50% of patients with ascites succumb in two years, 6 which has led to inclusion of ascites as one of the indications for initiating evaluation for liver transplantation. flank dullness is greater than usual, i.e., if the percussed air-fluid level is higher than that normally found on the lateral aspect of the abdomen with the patient supine, then ''shifting'' should be checked for.…”

“…The 24-month survival of patients with cirrhosis and ascites is 50%. 6 Once patients become refractory to routine medical therapy, 50% die within 6 months. 56 The 12-month survival of patients with ascites refractory to medical therapy is only 25%.…”

1 and 5 year survival estimates for people with cirrhosis of the liver in England, 1998–2009: A large population study

“…The prognosis of liver cirrhosis is only well described amongst non-representative groups of patients as previous studies were limited by geographical region [1][2][3], disease severity [4,5] or to a specific aetiology such as viral hepatitis B [6,7]. These studies are therefore of limited use in a clinical setting where patients with a range of aetiologies often ask about their prognosis, and they might also be misleading if used to advise how healthcare services should be tailored appropriately.…”

Empiric β-blockers for the prophylaxis of variceal hemorrhage: Cost effective or clinically applicable?

“…3 At the initial time of presentation with cirrhosis, about 30% of patients with compensated disease and 60% of those with decompensated disease have esophageal varices. 4 The annual risk of developing de novo varices after presentation appears to be around 8%.…”