Inequalities in Developing Cirrhosis Complications Over Time: A Cohort Study

Area of Science:

• Hepatology
• Clinical Epidemiology
• Chronic Liver Disease Research

Background:

• Current understanding of cirrhosis progression relies on outdated data.
• This study investigates contemporary cirrhosis progression patterns in a large veteran cohort.

Purpose of the Study:

• To analyze cirrhosis progression dynamics in a modern patient population.
• To identify factors influencing the transition from compensated cirrhosis to various complications or death.

Main Methods:

• Retrospective cohort study of 24,679 adult patients with compensated cirrhosis.
• Utilized a semi-Markov multistate model with 7 states and 15 transitions.
• Incorporated age and etiology (hepatitis C virus, alcohol, MASLD) as time-varying factors.

Main Results:

• Nearly 50% of patients progressed to a complication, most commonly ascites (30.3%).
• 12.9% transitioned directly to death from non-liver causes; 26% remained compensated.
• The 2-year mortality risk (13.5%) surpassed the risk of any complication.

Conclusions:

• Cirrhosis progression is heterogeneous, with significant portions progressing, remaining stable, or dying directly.
• Age and etiology (e.g., alcohol, active HCV) are key determinants of progression and outcomes.
• Interventions targeting the pre-complication phase are crucial for improving patient outcomes.