Long-term Clinical Course of Decompensated Alcoholic... : Journal of Clinical Gastroenterology (original) (raw)

LIVER, PANCREAS AND BILIARY TRACT: Original Articles

A Prospective Study of 165 Patients

Alvarez, Marco Antonio MD*,†; Cirera, Isabel MD, PhD†,‡; Solà, Ricard MD, PhD†,‡; Bargalló, Ana MD*,†; Morillas, Rosa Maria MD, PhD*,†,§; Planas, Ramon MD, PhD*,†,§

*Departament of Gastroenterology, Liver Unit, Hospital Universitari Germans Trias i Pujol

†Departament of Medicine, Universitat Autònoma de Barcelona

‡Liver Section, Service of Gastroenterology, Hospital del Mar, Parc de Salut Mar

§Centro de investigación biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain

There is no financial support.

The authors declare that they have nothing to disclose.

Reprints: Marco Antonio Alvarez, MD, Liver Unit, Departament of Gastroenterology, Hospital Universitari Germans Trias i Pujol, C/Del Canyet s/n. 08916 Badalona, Barcelona, Spain (e-mail: [email protected]).

Received October 22, 2010

Accepted June 8, 2011

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.