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Patients with liver cirrhosis show worse survival if decompensation occurs later during course of disease than at diagnosis

Nilsson, Emma LU ; Anderson, Harald LU ; Sargenti, Konstantina LU ; Lindgren, Stefan LU and Prytz, Hanne LU (2018) In Scandinavian Journal of Gastroenterology
Abstract

Objectives: Liver cirrhosis is characterized by a silent phase until decompensation, which is defined by onset of ascites, variceal bleeding, or encephalopathy. Although it is presumed that the survival of decompensated patients is the same regardless of when decompensation occurs, data to support this are scarce. We aimed to study the impact of time of decompensation on the clinical course and survival of patients with cirrhosis in a large population-based cohort. Materials and methods: We used medical registries to define a 10-year cohort of 1317 patients with incident liver cirrhosis in the Scania region of Sweden. Medical records were reviewed. Patients were followed until December 2011, and for death or transplantation until... (More)

Objectives: Liver cirrhosis is characterized by a silent phase until decompensation, which is defined by onset of ascites, variceal bleeding, or encephalopathy. Although it is presumed that the survival of decompensated patients is the same regardless of when decompensation occurs, data to support this are scarce. We aimed to study the impact of time of decompensation on the clinical course and survival of patients with cirrhosis in a large population-based cohort. Materials and methods: We used medical registries to define a 10-year cohort of 1317 patients with incident liver cirrhosis in the Scania region of Sweden. Medical records were reviewed. Patients were followed until December 2011, and for death or transplantation until December 2014. Results: In the cohort, 629 patients were decompensated at diagnosis, of which 505 had ascites and 44 variceal bleeding only. During follow-up, 228 patients developed ascites and 39 variceal bleeding as first complication. Patients with ascites as first complication showed worse survival than patients who had ascites at diagnosis. (5-year survival 33% vs. 15%, HR 1.60 (95% CI 1.34–1.90)). This difference persisted after adjustment for confounders, including hepatocellular cancer (HR 1.38 (95% CI 1.15–1.67)). Worse survival was also seen when bleeding from varices occurred during follow-up rather than at diagnosis. Conclusions: Our results provide evidence for an association between transplantation-free survival after decompensation and the time of decompensation in liver cirrhosis, with worse survival when decompensation occurs during follow-up, thus challenging the generally held, view that the survival after decompensation is independent of when decompensation occurs.

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author
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
ascites, Cirrhosis, decompensation, hepatic encephalopathy, hepatocellular cancer, liver, population-based cohort, prognosis, survival
in
Scandinavian Journal of Gastroenterology
pages
7 pages
publisher
Taylor & Francis
external identifiers
  • scopus:85043327210
ISSN
0036-5521
DOI
10.1080/00365521.2018.1447599
language
English
LU publication?
yes
id
b32fe874-fc8d-4c51-a11d-6d2f7975c667
date added to LUP
2018-04-05 14:19:47
date last changed
2018-05-29 11:57:02
@article{b32fe874-fc8d-4c51-a11d-6d2f7975c667,
  abstract     = {<p>Objectives: Liver cirrhosis is characterized by a silent phase until decompensation, which is defined by onset of ascites, variceal bleeding, or encephalopathy. Although it is presumed that the survival of decompensated patients is the same regardless of when decompensation occurs, data to support this are scarce. We aimed to study the impact of time of decompensation on the clinical course and survival of patients with cirrhosis in a large population-based cohort. Materials and methods: We used medical registries to define a 10-year cohort of 1317 patients with incident liver cirrhosis in the Scania region of Sweden. Medical records were reviewed. Patients were followed until December 2011, and for death or transplantation until December 2014. Results: In the cohort, 629 patients were decompensated at diagnosis, of which 505 had ascites and 44 variceal bleeding only. During follow-up, 228 patients developed ascites and 39 variceal bleeding as first complication. Patients with ascites as first complication showed worse survival than patients who had ascites at diagnosis. (5-year survival 33% vs. 15%, HR 1.60 (95% CI 1.34–1.90)). This difference persisted after adjustment for confounders, including hepatocellular cancer (HR 1.38 (95% CI 1.15–1.67)). Worse survival was also seen when bleeding from varices occurred during follow-up rather than at diagnosis. Conclusions: Our results provide evidence for an association between transplantation-free survival after decompensation and the time of decompensation in liver cirrhosis, with worse survival when decompensation occurs during follow-up, thus challenging the generally held, view that the survival after decompensation is independent of when decompensation occurs.</p>},
  author       = {Nilsson, Emma and Anderson, Harald and Sargenti, Konstantina and Lindgren, Stefan and Prytz, Hanne},
  issn         = {0036-5521},
  keyword      = {ascites,Cirrhosis,decompensation,hepatic encephalopathy,hepatocellular cancer,liver,population-based cohort,prognosis,survival},
  language     = {eng},
  month        = {03},
  pages        = {7},
  publisher    = {Taylor & Francis},
  series       = {Scandinavian Journal of Gastroenterology},
  title        = {Patients with liver cirrhosis show worse survival if decompensation occurs later during course of disease than at diagnosis},
  url          = {http://dx.doi.org/10.1080/00365521.2018.1447599},
  year         = {2018},
}