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Main causes of death in cirrhosis
Insights
Cirrhosis patients frequently die from liver failure and gastrointestinal bleeding. Prednisone treatment did not impact overall mortality causes in this long-term study.
Area of Science:
- Hepatology
- Internal Medicine
- Gastroenterology
Background:
- Cirrhosis is a chronic liver disease with significant mortality.
- Understanding the causes of death in cirrhosis is crucial for patient management.
- Previous studies have indicated various contributing factors to mortality.
Purpose of the Study:
- To identify the primary causes of death in a cohort of cirrhosis patients.
- To investigate the relationship between prognostic factors and mortality causes.
- To evaluate the effect of prednisone treatment on mortality patterns.
Main Methods:
- Longitudinal follow-up study of 532 patients with cirrhosis for up to 16 years.
- Analysis of death certificates and clinical data to determine causes of death.
- Statistical analysis to identify factors associated with mortality and treatment effects.
Main Results:
- Liver-related causes accounted for 57% of deaths, with liver failure and gastrointestinal bleeding being most common.
- Prognostic indicators at diagnosis, such as ascites and biochemical activity, correlated with higher liver-related mortality.
- Prednisone treatment showed no significant impact on the distribution or frequency of specific causes of death.
Conclusions:
- Liver failure and gastrointestinal bleeding are leading causes of death in cirrhosis.
- Prognostic factors at diagnosis are critical for predicting liver-related mortality.
- Prednisone is not effective in altering the causes of death in the general cirrhosis population.
Abstract:
The main causes of 436 deaths among 532 patients with cirrhosis followed up for up to 16 years constituted liver failure (24%), liver failure with gastrointestinal bleeding (13%), gastrointestinal bleeding (14%), primary liver cell carcinoma (4%), other liver-related causes (2%), infections (7%), cardiovascular diseases (22%), extrahepatic malignancies (9%), and other non-liver-related causes (5%). Totally, 57% died of liver-related causes. A high frequency of liver-related death was found among patients with a short observation time, high biochemical activity, pronounced change in liver architecture, ascites, and other signs of a poor prognosis at the time of diagnosis. The findings favoured the hypothesis that cirrhosis of the liver is a disease with an initial active and a subsequent inactive phase. Half of the patients were treated with prednisone, but this had no detectable influence on the distribution of causes of or on the frequency of single causes of death as infections or gastrointestinal bleeding. The group of patients responding favourably to prednisone treatment with regard to survival (non-alcoholic women without ascites) showed causes of death not different from those of the total material.