Clinical Course of Alcoholic Liver Cirrhosis: A Danish Population-Based Cohort Study

Abstract

The clinical course of alcoholic cirrhosis, a condition with a high mortality, has not been well described. We examined prevalence, risk, chronology, and mortality associated with three complications of cirrhosis: ascites, variceal bleeding, and hepatic encephalopathy. We followed a population-based cohort of 466 Danish patients diagnosed with alcoholic cirrhosis in 1993-2005, starting from the date of hospital diagnosis and ending in August 2006. Data were extracted from medical charts during the follow-up period. Risk and mortality associated with complications were calculated using competing-risks methods. At diagnosis of alcoholic cirrhosis, 24% of patients had no complications, 55% had ascites alone, 6% had variceal bleeding alone, 4% had ascites and variceal bleeding, and 11% had hepatic encephalopathy. One-year mortality was 17% among patients with no initial complications, 20% following variceal bleeding alone, 29% following ascites alone, 49% following ascites and variceal bleeding (from the onset of the later of the two complications), and 64% following hepatic encephalopathy. Five-year mortality ranged from 58% to 85%. The risk of complications was about 25% after 1 year and 50% after 5 years for all patients without hepatic encephalopathy. The complications under study did not develop in any predictable sequence. Although patients initially without complications usually developed ascites first (12% within 1 year), many developed either variceal bleeding first (6% within 1 year) or hepatic encephalopathy first (4% within 1 year). Subsequent complications occurred in an unpredictable order among patients with ascites or variceal bleeding. Conclusion: Patients with alcoholic cirrhosis had a high prevalence of complications at the time of cirrhosis diagnosis. The presence and type of complications at diagnosis were predictors of mortality, but not of the risk of subsequent complications. (HEPATOLOGY 2010;51:1675-1682

1 and 5 year survival estimates for people with cirrhosis of the liver in England, 1998–2009: A large population study

“…In comparison with our previous study [25], survival at 1-year in the ambulatory group was almost identical to those who had compensated cirrhosis according to their primary care records (87.3%) while survival at 1-year in the subsequent to hospitalisation group was worse than the survival of those who had decompensated cirrhosis (75%). This demonstrates how survival of severely ill patients is over estimated if only primary care records are used.…”

“…Our group and others [24,25] have shown previously that survival differs by disease stage i.e. compensated or decompensated cirrhosis.…”

Hepatocellular carcinoma surveillance in patients with alcoholic cirrhosis

“…The data also confirmed the poor prognosis in alcoholic cirrhosis in general [13,16]. In these patients, other complications and causes of death were more common than HCC -in fact, only 1.8% of all deaths were due to HCC.…”

“…In that study, the annual risk of HCC was taken to be 1.7% in alcoholic cirrhosis. If they had used 0.25 or 0.50% as in the Danish nationwide study [16], or 0.20% as presented in an abstract from the UK [17], their cost estimate would evidently have been three-or four-times higher. Altogether, we do not think that universal surveillance of patients with alcoholic cirrhosis for HCC development is justified by the currently available evidence.…”

Usefulness of a New Prognostic Index for Alcoholic Hepatitis

“…Among the problems presented by AH patients, mainly when there is associated cirrhosis, ascites is generally one of the first complications to appear. In addition, HE is related to the highest mortality (10) . In medical practice, the score previously mentioned might help recognize AH patients who present risk of those complications, and thereby start appropriate therapy.…”