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Survival and prognostic indicators in compensated and decompensated cirrhosis
Insights
Cirrhosis survival is significantly lower in decompensated patients. Key predictors of death risk include liver failure, hepatocellular carcinoma, and bleeding, with specific factors varying by disease stage.
Area of Science:
- Hepatology
- Internal Medicine
- Clinical Research
Background:
- Cirrhosis impacts millions globally, necessitating accurate prognostic tools.
- Understanding survival predictors is crucial for patient management and treatment strategies.
Purpose of the Study:
- To assess six-year survival rates in a large cohort of cirrhosis patients.
- To identify significant prognostic variables for compensated and decompensated cirrhosis.
Main Methods:
- A retrospective analysis of 1155 consecutive cirrhosis patients.
- Cox's regression model was used to evaluate 21 potential prognostic variables.
Main Results:
- Six-year survival was 54% for compensated and 21% for decompensated patients.
- Significant predictors in compensated disease included male sex, HBsAg positivity, age, prothrombin time, and esophageal varices.
- Decompensated disease predictors included hepatocellular carcinoma, encephalopathy, hemorrhage, liver enzymes, alcohol abuse, and HBsAg positivity.
Conclusions:
- Prognosis differs significantly between compensated and decompensated cirrhosis.
- A prognostic index incorporating key variables can aid in risk stratification for cirrhosis patients.
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.