6533b822fe1ef96bd127d8ad

RESEARCH PRODUCT

Mortality risk according to different clinical characteristics of first episode of liver decompensation in cirrhotic patients: a nationwide, prospective, 3-year follow-up study in Italy.

Savino BrunoSaibeni SimoneBagnardi VincenzoVandelli CarmenDe Luca MassimoFelder MartinaFracanzani Anna LudovicaPrisco CleofeVitaliani GiovannaSimone LoredanaGaeta Giovanni BattistaStanzione MariaMarcello PersicoFurlan CaterinaStroffolini TommasoSalerno FrancescoPatrick MaisonneuveAlmasio Piero LuigiNiro G A

subject

AdultLiver CirrhosisMalemedicine.medical_specialtyPediatricsCarcinoma HepatocellularCirrhosisAdolescentmedicine.medical_treatmentCirrhosis Mortality Liver decompensation CohortLiver transplantationEsophageal and Gastric VaricesSeverity of Illness IndexYoung AdultSeverity of illnessmedicineHumansProspective StudiesYoung adultIntensive care medicineProspective cohort studyHepatic encephalopathyAgedProportional Hazards ModelsAged 80 and overFirst episodeHepatologybusiness.industryLiver NeoplasmsGastroenterologyAscitesMiddle Agedmedicine.diseaseLiver TransplantationAdolescent; Adult; Aged; Aged 80 and over; Ascites; Carcinoma Hepatocellular; Esophageal and Gastric Varices; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Hepatic Encephalopathy; Humans; Italy; Liver Cirrhosis; Liver Failure; Liver Neoplasms; Liver Transplantation; Male; Middle Aged; Multivariate Analysis; Proportional Hazards Models; Prospective Studies; Severity of Illness Index; Young AdultItalyCirrhosisHepatic EncephalopathyMultivariate AnalysisCohortFemaleGastrointestinal HemorrhagebusinessLiver FailureFollow-Up Studies

description

Abstract OBJECTIVES: The occurrence of decompensation marks a crucial turning point in the course of cirrhosis. The purpose of this study was to assess the risk of mortality according to the clinical characteristics of first decompensation, considering also the impact of acute-on-chronic liver failure (AoCLF). METHODS: We conducted a prospective nationwide inception cohort study in Italy. Decompensation was defined by the presence of ascites, either overt or detected by ultrasonography (UD), gastroesophageal variceal bleeding (GEVB), and hepatic encephalopathy (HE). AoCLF was defined according to the Asian Pacific Association for the Study of the Liver criteria. Multivariable Cox proportional hazards regression was used to analyze the risk of failure (death or orthotopic liver transplantation (OLT)). RESULTS: A total of 490 consecutive cirrhotic patients (314 males, mean age 60.9±12.6 years) fulfilled the study criteria. AoCLF was identified in 59 patients (12.0%). Among the remaining 431 patients, ascites were found in 330 patients (76.6%): in 257 (77.8%) as overt ascites and in 73 (22.2%) as UD ascites. GEVB was observed in 77 patients (17.9%) and HE in 30 patients (7.0%). After a median follow-up of 33 months, 24 patients underwent OLT and 125 died. The cumulative incidence of failure (death or OLT) after 1, 2, and 3 years was, respectively, 28, 53, and 62% in patients with AoCLF; 10, 18, and 25% in patients with UD ascites; 17, 31, and 41% in patients with overt ascites; and 8, 12, and 24% in patients with GEVB (P<0.0001). CONCLUSIONS: AoCLF is responsible for a relevant proportion of first decompensation in cirrhotic patients and is associated with the poorest outcome. Patients with UD ascites do not have a negligible mortality rate and require clinical monitoring similar to that of patients with overt ascites.

yearjournalcountryeditionlanguage
2013-01-01
10.1038/ajg.2013.110http://hdl.handle.net/10447/81104