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Competing risks and prognostic stages of cirrhosis

The development of esophago-gastric varices and decompensating events in cirrhosis identify 5 prognostic stages with significantly increasing mortality risks, reports this month's Alimentary Pharmacology & Therapeutics.

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Morphological, hemodynamic and clinical stages of cirrhosis have been proposed, although no definite staging system is yet accepted for clinical practice.

Dr D'Amico and colleagues from Italy investigated whether clinical complications of cirrhosis may define different prognostic disease stages.

Analysis of the database from a prospective inception cohort of 494 patients.

Decompensation was defined by ascites, bleeding, jaundice or encephalopathy.

Explored potential prognostic stages compensated cirrhosis without esophago-gastric varices, compensated cirrhosis with varices, bleeding without other complications, first nonbleeding decompensation, any second decompensating event.

Patient flow across stages was assessed by a competing risks analysis.

5-year transition rate towards a different stage, for stages 4 was 78%
Alimentary Pharmacology & Therapeutics

Major patient characteristics were 199 females, 295 males, 404 HCV+, 377 compensated, 117 decompensated cirrhosis.

The mean follow-up was 145 months without dropouts.

Major events 380 deaths, 326 esophago-gastric varices, 283 ascites, 158 bleeding, 146 encephalopathy, 113 jaundice, 126 hepatocellular carcinoma, and 19 liver transplantation.

The research team found that 5-year transition rate towards a different stage, for stages 1–4 was 34.5%, 42%, 65% and 78%, respectively.

The team observed that 5-year mortality for stages 1–5 was 1.5%, 10%, 20%, 30% and 88% respectively.

An exploratory analysis showed that this patient stratification may configure a prognostic system independent of the Child–Pugh score, Model for End Stage Liver Disease and comorbidity.

Dr D'Amico's team concludes, "The development of esophago-gastric varices and decompensating events in cirrhosis identify 5 prognostic stages with significantly increasing mortality risks."

Aliment Pharmacol Ther 2014: 39(10): 1180–1193
08 May 2014

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