Survival and prognostic indicators in compensated and decompensated cirrhosis

Abstract

Six-year survival of cirrhosis was assessed in a series of 1155 consecutive patients (751 men, 404 women). Among the men, 33% were alcoholics and 18% were HBsAg positive; corresponding figures for the women were 15% and 6%, respectively. Features of decompensation at first presentation were observed in 63% of the patients. Six-year survival was 54% in compensated and 21% in decompensated patients. No significant differences in survival were found between alcoholics and nonalcoholics. Leading causes of death were liver failure (49%), hepatocellular carcinoma (22%), and bleeding (13%). The prognostic role of 21 variables was evaluated separately in compensated and decompensated patients by the Cox's regression model. The following variables were found to be significant predictors of death risk in compensated patients: male sex, HBsAg positivity, age, prothrombin time prolongation, and esophageal varices. In decompensated disease the significant indicators of death risk were: hepatocellular carcinoma, encephalopathy, hemorrhage, SGOT, esophageal varices, gamma globulins, prothrombin time prolongation, continued abuse of alcohol, HBsAg positivity, gamma glutamyl transpeptidase, and cholinesterase. A simple prognostic index based upon the relative risk coefficient of the significant variables is suggested.

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References

  1. 1.

    Istututo Centrale di Statistica: Annuario Statistico Italiano. Roma, ISTAT, 1982, p 337

  2. 2.

    Pagliaro L, Saracci R, Bardelli D, Filippazzo G: Chronic liver disease, alcohol consumption and HBsAg antigen in Italy: A multiregional case-control study. Ital J Gastroenterol 14:90–95, 1982

    Google Scholar 

  3. 3.

    Pagliaro L, Rinaldi F, Craxì A, Di Piazza S, Filippazzo G, Gatto G, Genova G, Magrin S, Maringhini A, Orsini S, Palazzo U, Spinello M, Vinci M: Percutaneous blind biopsy versus laparoscopy with guided biopsy in diagnosis of cirrhosis. A prospective randomized trial. Dig Dis Sci 28:39–43, 1983

    Google Scholar 

  4. 4.

    Scheuer PJ: Cirrhosis.In Pathology of the Liver. RNM MacSween, PP Anthony, PJ Scheuer (eds). London, Churchill Livingstone, 1974, pp 258–271

    Google Scholar 

  5. 5.

    Anthony PP, Ishak KG, Nayak NC, Poulsen HE, Scheuer PJ, Sobin LH: The morphology of cirrhosis: Definition, nomenclature and classification. Bull WHO 55:521–540, 1977

    Google Scholar 

  6. 6.

    Kaplan EL, Meier P: Nonparametric estimation from incomplete observation. J Am Stat Assoc 53:457–481, 1958

    Google Scholar 

  7. 7.

    Cox DR: Regression models and life tables. J R Stat Soc 34B:187–220, 1972

    Google Scholar 

  8. 8.

    Powell WJ, Klatskin G: Duration of survival in patients with Laennec's cirrhosis. Am J Med 44:406–420, 1968

    Google Scholar 

  9. 9.

    Borowsky SA, Strome S, Lott E: Continued heavy drinking and survival in alcoholic cirrhotics. Gastroenterology 80:1045–1049, 1981

    Google Scholar 

  10. 10.

    Reynolds TG: Good news for drinkers-or is it? Gastroenterology 74:153–154, 1978

    Google Scholar 

  11. 11.

    Saunders JB, Walters JRF, Davies P, Paton A: A 20-year prospective study of cirrhosis. Br Med J 282:263–266, 1981

    Google Scholar 

  12. 12.

    Ratnoff OD, Patek AJ: Natural history of Laennec's cirrhosis of liver: Analysis of 386 cases. Medicine 21:207–268, 1942

    Google Scholar 

  13. 13.

    Garceau AJ, Chalmers TC, Boston Inter-Hospital Liver Group. The natural history of cirrhosis. I. Survival with esophageal varices. N Engl J Med 268:469–473, 1963

    Google Scholar 

  14. 14.

    Copenhagen Study Group for Liver Diseases: Effect of prednisone on the survival of patients with cirrhosis of the liver. Lancet 1:119–121, 1969

    Google Scholar 

  15. 15.

    Pagliaro L, Simonetti RG, Craxì A, Spanò C, Filippazzo G, Palazzo U, Patti S, Giannuoli G, Marraffa A, Colombo M, Tommasini M, Bellentani S, Villa E, Manenti F, Caporaso N, Coltorti M, Del Vecchio Blanco C, Farsi P, Smedile A, Verme G: Alcohol and HBB infection as risk factors for hepatocellular carcinoma in Italy: A multicentric controlled study. Hepatogastroenterology 30:48–50, 1983

    Google Scholar 

  16. 16.

    Schlichting P, Christensen E, Andersen PK, Fauerholdt L, Juhl E, Poulsen H, Tygstrup N, Copenhagen Study Group for Liver Diseases: Prognostic factors in cirrhosis identified by Cox's regression model. Hepatology 3:889–895, 1983

    Google Scholar 

  17. 17.

    Morabito A, Marubini E: TABSUR: a program featured to aid statistical analysis in cancer clinical research.In Analyse des données, Actes de la journée de travail, Naples 30 Juin–5 Juilliet 1980. Institute National de Recherche en Informatique et en automatique. France, Le Chesnay, 1980 pp 393–408.

    Google Scholar 

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Correspondence to Dr. Gennaro D'amico MD.

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Members of the Liver Study Group are: Maria Caltagirone, Gabriella Filippazzo, Giovanni Gatto, Gandolfo Giannuoli, Silvio Margin, Guiseppe Malizia, Lorenzo Maniaci, Maria Pia Marcenó, Alberto Maringhini, Rocco Micciolo, Salvatore Orsini, Fabio Pace, Ugo Palazzo, Linda Pasta, Giuseppina Russo, Rosa Giovanna Simonetti, Mario Spinello, Mario Traina, Mario Valenza, Maria Vinci, Giovanni Vizzini.

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D'amico, G., Morabito, A., Pagliaro, L. et al. Survival and prognostic indicators in compensated and decompensated cirrhosis. Digest Dis Sci 31, 468–475 (1986). https://doi.org/10.1007/BF01320309

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Keywords

  • Hepatocellular Carcinoma
  • Cholinesterase
  • Esophageal Varix
  • Prognostic Index
  • Prognostic Role