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 21 February 2018

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Long-term prognosis of patients with alcoholic liver cirrhosis: a 15-year follow-up

A study in September's Scandinavian Journal of Gastroenterology reports that a high level of alkaline phosphatase is one of many independent predictors of poor prognosis for patients with advanced cirrhosis.

News image

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Most follow-up studies that have been undertaken previously in patients with alcoholic liver cirrhosis have been for a 5-year period or less.

A research group from Norway, studied the long-term mortality and causes of death among patients with alcoholic liver cirrhosis and identified predictors of mortality.

In total, 100 patients consecutively admitted to one medical department with alcoholic liver cirrhosis were included in the study from May 1984 until December 1988.

All patients had a history of alcohol abuse of at least 100g ethanol daily for several years.

The study comprised 65 men and 35 women with a median age of 58 years (range 34-82).

Percutaneous liver biopsies and/or autopsies were obtained on 89 patients.

Sixty-seven had ascites at admission and 34% had bleeding esophageal varices.

The research group followed all patients prospectively until death or until October 2000.

During the follow-up period 90% of the patients died, 68 of whom (76 %) had been autopsied.

Independent and significant predictors of mortality were: age, alcohol abuse and alkaline phosphatase
Scandinavian Journal of Gastroenterology

The cumulative actuarial mortality after 1, 3, 6 and 12 months was 18%, 28%, 36% and 49%, respectively and after 5, 10 and 15 years 71%, 84% and 90%, respectively.

None of the patients underwent liver transplantation during the study.

The group analyzed the data to show that the causes of death were bleeding, liver failure or a combination of these two conditions in 52 of 90 patients (58%), while 9 (11%) died of hepatocellular carcinoma 0.5 to 73 months after inclusion in the study.

The researchers used Cox regression analysis to identify independent and significant predictors of mortality which were: age, alcohol abuse and alkaline phosphatase. Child-Pugh class was not.

The group concluded that the mortality in a group of patients with advanced alcoholic cirrhosis was extremely high, 71% at 5 years and 90% at 15 years.

Dr Sandvik added that "The Independent predictors of a poor prognosis were high age, continuous alcohol consumption of more than 10 g ethanol per day and high levels of alkaline phosphatase."

Scandinavian Journal of Gastroenterology; 2004: 39 (9): 858-863
28 September 2004

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