Published online Jul 27, 2014. doi: 10.4254/wjh.v6.i7.504
Revised: May 16, 2014
Accepted: June 10, 2014
Published online: July 27, 2014
AIM: To study these characteristics and prognostic patterns in a Greek patient population.
METHODS: We analyzed a large cohort of cirrhotic patients referred to the department of Gastroenterology and Hepatology and the outpatient clinics of this tertiary hospital, between 1991 and 2008. We included patients with established cirrhosis, either compensated or decompensated, and further decompensation episodes were registered. A data base was maintained and updated prospectively throughout the study period. We analyzed differences in cirrhosis aetiology, time to and mode of decompensation, hepatocellular carcinoma (HCC) occurrence and ultimately patient survival.
RESULTS: Five hundreds and twenty-two patients with median age 67 (range, 29-91) years and average follow up 9 years-10 mo (range, 1-206 mo) were studied. Commonest aetiology was hepatitis C virus (HCV, 41%) followed by alcohol (31%). The median survival time in compensated cirrhotics was 115 mo (95%CI: 95-133), whereas in decompensated patients was 55 mo (95%CI: 36-75). HCV patients survived longer while HBV patients had over twice the risk of death of HCV patients. The median time to decompensation was 65 mo (95%CI: 51-79), with alcoholics having the highest risk (RR = 2.1 vs HCV patients). Hepatitis B virus (HBV) patients had the highest risk of HCC, alcoholics the lowest. Leading causes of death: liver failure, hepatorenal syndrome, sepsis and HCC progression.
CONCLUSION: Cirrhosis aetiology and decompensation at presentation were predictors of survival. Alcoholics had the highest decompensation risk, HBV cirrhotics the highest risk of HCC and HCV cirrhotics the highest decompensation-free time.
Core tip: Hepatitis C was the most common cause in our cirrhotics and many hepatitis C virus patients were aged and demonstrated a long, mild course. Alcoholic and non alcoholic steatohepatitis cirrhosis is becoming a significant problem. Ascites was the commonest type of decompensation. Survival in compensated cirrhotics was at least double that of decompensated patients. Variceal bleeding was more frequent in alcoholics; nevertheless it was unexpectedly related to better survival than decompensation with ascites or encephalopathy. This was attributed to the improvements in the management of variceal bleeding together with the importance of abstinence from alcohol after the episode was successfully treated. Hepatocellular carcinoma patients with a history of hepatitis B virus had the highest risk of mortality.