Retrospective Study
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World J Hepatol. Jul 27, 2014; 6(7): 504-512
Published online Jul 27, 2014. doi: 10.4254/wjh.v6.i7.504
Clinical outcomes of compensated and decompensated cirrhosis: A long term study
Dimitrios N Samonakis, Mairi Koulentaki, Constantina Coucoutsi, Aikaterini Augoustaki, Chryssavgi Baritaki, Emmanuel Digenakis, Nikolaos Papiamonis, Maria Fragaki, Erminia Matrella, Maria Tzardi, Elias A Kouroumalis
Dimitrios N Samonakis, Mairi Koulentaki, Constantina Coucoutsi, Aikaterini Augoustaki, Chryssavgi Baritaki, Emmanuel Digenakis, Nikolaos Papiamonis, Maria Fragaki, Erminia Matrella, Elias A Kouroumalis, Department of Gastroenterology and Hepatology, University Hospital of Heraklion, Heraklion 71110, Crete, Greece
Maria Tzardi, Department of Histopathology, University Hospital of Heraklion, Heraklion 71110, Crete, Greece
Author contributions: Samonakis DN wrote the manuscript, did the statistics and was responsible for patient management; Koulentaki M contributed to data base design, patient management and paper corrections; Coucoutsi C, Augustaki A and Baritaki C kept data base and patient management; Digenakis E, Papiamonis N and Fragaki M contributed to patient management and data base update, patient survival follow up; Matrella E contributed to long term patient management and outpatient clinic details; Tzardi M diagnosed all liver biopsies; Kouroumalis EA contributed to the study design, patient managment, contributed to the manuscript, had overall responsibility for the study.
Correspondence to: Dr. Dimitrios N Samonakis, Department of Gastroenterology and Hepatology, University Hospital of Heraklion, Buidling A-4th Floor, Voutes, Herklion 71110, Crete, Greece. dsamonakis@gmail.com
Telephone: +30-2810-392356 Fax: +30-2810-542085
Received: December 27, 2013
Revised: May 16, 2014
Accepted: June 10, 2014
Published online: July 27, 2014
Processing time: 209 Days and 23.6 Hours
Abstract

AIM: To study these characteristics and prognostic patterns in a Greek patient population.

METHODS: We analyzed a large cohort of cirrhotic patients referred to the department of Gastroenterology and Hepatology and the outpatient clinics of this tertiary hospital, between 1991 and 2008. We included patients with established cirrhosis, either compensated or decompensated, and further decompensation episodes were registered. A data base was maintained and updated prospectively throughout the study period. We analyzed differences in cirrhosis aetiology, time to and mode of decompensation, hepatocellular carcinoma (HCC) occurrence and ultimately patient survival.

RESULTS: Five hundreds and twenty-two patients with median age 67 (range, 29-91) years and average follow up 9 years-10 mo (range, 1-206 mo) were studied. Commonest aetiology was hepatitis C virus (HCV, 41%) followed by alcohol (31%). The median survival time in compensated cirrhotics was 115 mo (95%CI: 95-133), whereas in decompensated patients was 55 mo (95%CI: 36-75). HCV patients survived longer while HBV patients had over twice the risk of death of HCV patients. The median time to decompensation was 65 mo (95%CI: 51-79), with alcoholics having the highest risk (RR = 2.1 vs HCV patients). Hepatitis B virus (HBV) patients had the highest risk of HCC, alcoholics the lowest. Leading causes of death: liver failure, hepatorenal syndrome, sepsis and HCC progression.

CONCLUSION: Cirrhosis aetiology and decompensation at presentation were predictors of survival. Alcoholics had the highest decompensation risk, HBV cirrhotics the highest risk of HCC and HCV cirrhotics the highest decompensation-free time.

Keywords: Survival; Decompensation; Hepatocellular carcinoma; Bleeding; Ascites

Core tip: Hepatitis C was the most common cause in our cirrhotics and many hepatitis C virus patients were aged and demonstrated a long, mild course. Alcoholic and non alcoholic steatohepatitis cirrhosis is becoming a significant problem. Ascites was the commonest type of decompensation. Survival in compensated cirrhotics was at least double that of decompensated patients. Variceal bleeding was more frequent in alcoholics; nevertheless it was unexpectedly related to better survival than decompensation with ascites or encephalopathy. This was attributed to the improvements in the management of variceal bleeding together with the importance of abstinence from alcohol after the episode was successfully treated. Hepatocellular carcinoma patients with a history of hepatitis B virus had the highest risk of mortality.