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Mortality risk according to different characteristics of liver decompensation in cirrhosis

A study in the latest issue of the American Journal of Gastroenterology prospectively evaluates mortality risk according to different clinical characteristics of first episode of liver decompensation in cirrhotic patients.

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The occurrence of decompensation marks a crucial turning point in the course of cirrhosis.

Dr Savino Bruno and colleagues from Italy assessed the risk of mortality according to the clinical characteristics of first decompensation, considering also the impact of acute-on-chronic liver failure.

The team conducted a prospective nationwide inception cohort study in Italy.

Decompensation was defined by the presence of ascites, either overt or detected by ultrasonography, gastroesophageal variceal bleeding, and hepatic encephalopathy.

The researchers defined acute-on-chronic liver failure 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 liver transplantation.

A total of 490 consecutive cirrhotic patients fulfilled the study criteria.

The doctors identified acute-on-chronic liver failure in 59 patients.

Among the remaining 431 patients, ascites were found in 330 patients as overt ascites and in 73 as ultrasonography ascites.

The cumulative incidence of failure after 3 years in patients with overt ascites was 41%
American Journal of Gastroenterology

Gastroesophageal variceal bleeding was observed in 77 patients, and hepatic encephalopathy in 30 patients.

The researchers noted that after a median follow-up of 33 months, 24 patients underwent liver transplantation and 125 died.

The cumulative incidence of failure after 1, 2, and 3 years was, respectively, 28%, 53%, and 62% in patients with acute-on-chronic liver failure, and 10%, 18%, and 25% in patients with ultrasonography ascites.

The cumulative incidence of failure after 1, 2, and 3 years in patients with overt ascites was 17%, 31%, and 41%, respectively.

The cumulative incidence of failure after 1, 2, and 3 years in patients with gastroesophageal variceal bleeding.was 8%, 12%, and 24% in patients.

Dr Bruno's team commented, "Acute-on-chronic liver failure is responsible for a relevant proportion of first decompensation in cirrhotic patients and is associated with the poorest outcome."

"Patients with ultrasonography ascites do not have a negligible mortality rate and require clinical monitoring similar to that of patients with overt ascites."

Am J Gastroenterol 2013; 108:1112–1122
12 July 2013

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