Long-term clinical course of decompensated alcoholic cirrhosis: A prospective study of 165 patients

Marco Antonio Alvarez, Isabel Cirera, Ricard Solà, Ana Bargalló, Rosa Maria Morillas, Ramon Planas

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Abstract

Background: Prognosis of decompensated alcoholic cirrhosis is based mainly on studies that included patients with different severities of liver disease and did not recognize either hepatitis C virus epidemic or changes in clinical management of cirrhosis. Aim: To define the long-term course after the first hepatic decompensation in alcoholic cirrhosis. Methods: Prospective inclusion at the start point of decompensated cirrhosis of 165 consecutive patients with alcoholic cirrhosis without known hepatocellular carcinoma hospitalized from January 1998 to December 2001 was made. Follow-up was maintained until death or the end of the observation period (April 1, 2010). Results: The patients were followed for 835.75 patient years. Median age was 56 years (95% confidence interval: 54-58). Baseline Child-Pugh score was 9 (95% CI: 8-9), and model for end-stage liver disease (MELD) was 13.8 (95% CI: 12.5-14.7). Ascites was the most frequent first decompensation (51%). During follow-up, 99 (60%) patients were abstinent, hepatocellular carcinoma developed in 18 (11%) patients, and 116 patients died (70%). Median overall survival was 61 months (95% CI: 48-74). Median survival probability after onset of hepatic encephalopathy (HE) was only 14 months (95% CI: 5-23). Age, baseline MELD, albumin, development of HE, and persistence of alcohol use were independently correlated with mortality. Conclusions: Patients with alcoholic cirrhosis show a high frequency of complications. The low mortality rate in our cohort of patients probably reflects the improvement in the management of patients with cirrhosis; it is mainly influenced by baseline MELD, age, HE development, and continued abstinence. Patients who develop HE should be considered for hepatic transplantation. Copyright © 2011 by Lippincott Williams & Wilkins.
Original languageEnglish
Pages (from-to)906-911
JournalJournal of Clinical Gastroenterology
Volume45
Issue number10
DOIs
Publication statusPublished - 1 Nov 2011

Keywords

  • Child-Pugh score
  • cirrhosis
  • hepatic encephalopathy
  • hepatocellular carcinoma
  • model for end-stage liver disease
  • prognosis
  • survival

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