Long-term clinical course of decompensated alcoholic cirrhosis: a prospective study of 165 patients.
J Clin Gastroenterol
; 45(10): 906-11, 2011.
Article
en En
| MEDLINE
| ID: mdl-21814145
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.
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Encefalopatía Hepática
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Carcinoma Hepatocelular
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Cirrosis Hepática Alcohólica
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Neoplasias Hepáticas
Tipo de estudio:
Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
J Clin Gastroenterol
Año:
2011
Tipo del documento:
Article
País de afiliación:
España