Advertisement

Digestive Diseases and Sciences

, Volume 40, Issue 8, pp 1805–1815 | Cite as

Prognosis and life expectancy in chronic liver disease

  • Albert Propst
  • Theresa Propst
  • Günther Zangerl
  • Dietmar Öfner
  • Gert Judmaier
  • Wolfgang Vogel
Liver: Cirrhosis, Fibrosis, Portal Hypertension, and Transplantation

Abstract

The aim of the present study was to define prognosis and life expectancy in patients with chronic liver disease of different etiologies and to relate them to an age- and sex-matched normal population. After a follow-up of 15 years, life expectancy of 620 patients with chronic liver disease was retrospectively calculated and compared with an age- and sex-matched normal population. Among patients with cirrhosis, prognosis was dependent upon the Child classification (P=0.001). Patients with alcoholic cirrhosis and fatty liver disease were younger (P=0.01) and had a lower life expectancy than patients with other causes of chronic liver disease (P=0.004). Patients with hepatitis B and hepatitis C cirrhosis showed a comparable prognosis and a significantly lower life expectancy than the age- and sex-matched population. Cryptogenic and autoimmune liver diseases showed a comparable life expectancy but a significantly shorter life expectancy than the normal population. In patients withα1-antitrypsin deficiency-associated cirrhosis, a high viral coinfection rate was found (P=0.01). For patients with noncirrhotic hemochromatosis, prognosis was poorer than that for the age- and sex-matched population. In patients with asymptomatic primary biliary cirrhosis, chronic persistent hepatitis B, andα1-antitrypsin deficiency without cirrhosis, life expectancy was equal to that of the normal population. Prognosis and life expectancy in chronic liver disease depend on stage, cause, and symptoms of chronic liver disease; age; and possibilities of treatment. In patients with hereditary liver disease, additional viral infection or alcohol abuse lead to a significant deterioration of life expectancy. Patients with alcoholic chronic liver disease have the poorest prognosis.

Key Words

prognosis life expectancy liver cirrhosis chronic hepatitis fatty liver disease 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Sherlock S: European livers. Lancet 342:1127–1128, 1993Google Scholar
  2. 2.
    Office of Population Censuses and Surveys: Mortality statistics. Review of the Registar General on deaths in England and Wales, 1974 et seq. London, HMSO, 1979Google Scholar
  3. 3.
    Powell WJ, Klatskin G: Duration of survival in patients with Laennec's cirrhosis. Am J Med 44:406–420, 1968Google Scholar
  4. 4.
    Saunders JB, Walters JRF, Davies P, Paton A: A 20-year prospective study of cirrhosis. Br Med J 282:263–266, 1981Google Scholar
  5. 5.
    Gines P, Arroyo V, Rodes J: Treatment of ascites and renal failure in cirrhosis.In Therapy of Liver Diseases, Baliere's Clinics in Gastroenterology. M Davis, (ed). London, WB Saunders, 1989, pp 165–186Google Scholar
  6. 6.
    Llach J, Gines P, Arroyo V, Rimola A, Tito L, Badalamenti S: Prognostic value of arterial pressure, endogenous vasoactive systems and renal function in cirrhosis with ascites. Gastroenterology 94:482–487, 1988Google Scholar
  7. 7.
    Ratnoff OD, Patek AJ Jr: The natural history of Laennec's cirrhosis of the liver: analysis of 386 cases. Medicine 21:207–268, 1942Google Scholar
  8. 8.
    D'Amico G, Morabito A, Pagliaro L, Marubini E, Liver Study Group of 'V. Cervello' Hospital: Survival and prognostic indicators in compensated and decompensated cirrhosis. Dig Dis Sci 31:468–475, 1986Google Scholar
  9. 9.
    Pugh RNH, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R: Transection of oesophagus for bleeding oesophageal varices. Br J Surg 60:646–649, 1973Google Scholar
  10. 10.
    Hosein B, Fang CT, Popovsky MA: Improved serodiagnosis of hepatitis C virus infection with synthetic peptide antigen from capsid protein. Proc Natl Acad Sci USA 88:3647–3651, 1991Google Scholar
  11. 11.
    Czaja AJ, Manns MP, Homburger HA: Frequency and significance of antibodies to liver/kidney microsome type 1 in adults with chronic active hepatitis. Gastroenterology 103:1290–1295, 1992Google Scholar
  12. 12.
    Cox DW, Johnson AM, Fagerhol MK: Report of nomenclature meeting for alpha1-antitrypsin. Hum Genet 171:731–733, 1980Google Scholar
  13. 13.
    Bassett M, Halliday JW, Powell LW: Value of iron measurements in early hemochromatosis and determination of the critical iron level associated with fibrosis. Hepatology 6:24–29, 1986Google Scholar
  14. 14.
    Kaplan EL, Meier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481, 1958Google Scholar
  15. 15.
    Sherlock S: Chronic hepatitis. Gut 15:581–597, 1974Google Scholar
  16. 16.
    Weissberg JI, Andres LL, Smith CI, Weick S, Nichols JE, Garcia G: Survival in chronic hepatitis B: An Intern Med 101:613–616, 1984Google Scholar
  17. 17.
    Schalm SW, Summerskill WHJ, Gitnick GL, Elveback LR: Contrasting feature and responses to treatment of severe chronic active liver disease with and without HbsAg. Gut 17:781–786, 1976Google Scholar
  18. 18.
    Seeff LB, Buskeli-Bales Z, Wright E, Durako St, Alter HJ, Iber FL: Long-term mortality after transfusion-associated non-A, non-B hepatitis. N Engl J Med 327:1906–1911, 1992Google Scholar
  19. 19.
    Tremolada F, Casarin C, Alberti A, Drago C, Tagger A, Ribero ML: Long-term follow-up of non-A, non-B (type C) post-transfusion hepatitis. J Hepatol 16:273–281, 1992Google Scholar
  20. 20.
    Tremolada F, Benvegnu' L, Casarin C, Pontisso P, Tagger A, Alberti A: Antibody to hepatitis C virus in hepatocellular carcinoma. Lancet 335:300–301, 1990Google Scholar
  21. 21.
    Tremolada F, Casarin C, Tagger A, Ribero ML, Realdi G, Alberti A: Antibodies to hepatitis C virus in post-transfusion hepatitis. Ann Intern Med 114:277–281, 1991Google Scholar
  22. 22.
    Bortolotti F, Tagger A, Cadrobbi P, Crivellaro C, Pregliasco F, Ribero ML: Antibodies to hepatitis C virus in communityacquired acute non-A, non-B hepatitis. J Hepatol 12:176–180, 1991Google Scholar
  23. 23.
    Czaja AJ, Hay HE, Rakela J: Clinical features and prognostic implications of severe corticosteroid-treated cryptogenic chronic active hepatitis. Mayo Clin Proc 65:23–30, 1990Google Scholar
  24. 24.
    Jeffers LJ, Hasan F, DeMedina M, Reddy R, Parker T, Silva M: Prevalence of autoantibodies to hepatitis C virus among patients with cryptogenic chronic hepatitis and cirrhosis. Hepatology 15:187–190, 1992Google Scholar
  25. 25.
    Czaja AJ, Carpenter HA, Santrach PJ, Moore B, Homburger HA: The nature and prognosis of severe cryptogenic chronic active hepatitis. Gastroenterology 104:1755–1761, 1993Google Scholar
  26. 26.
    Schenker G: Alcoholic liver disease: Evaluation of natural history and prognostic factors. Hepatology 4:365–435, 1984Google Scholar
  27. 27.
    Saunders JB, Walters JRF, Davies P: A 20-year prospective study of cirrhosis: Br Med J 282:263–266, 1981Google Scholar
  28. 28.
    Powell WJ Jr, Klatskin G: Duration of survival in patients with Laennec's cirrhosis of the liver: An analysis of 386 cases. Medicine 21:207–268, 1942Google Scholar
  29. 29.
    Borowsky SA, Strome S, Lott E: Continued heavy drinking and survival in alcoholic cirrhosis. Gastroenterology 80:1405–1409, 1981Google Scholar
  30. 30.
    Soterakis J, Resnick RH, Iber F: Effect of alcohol abstinence on survival in cirrhotic portal hypertension. Lancet 2:65–67, 1973Google Scholar
  31. 31.
    Pande NV, Resnick RH, Yee W, Eckardt VF, Shurberg JL: Cirrhotic portal hypertension: Morbidity of continued alcoholism. Gastroenterology 74:64–69, 1978Google Scholar
  32. 32.
    Strohmeyer G, Niederau C, Stemmel W: Survival and causes of death in hemochromatosis. Observations in 163 patients. Ann NY Acad Sci 526:245–257, 1988Google Scholar
  33. 33.
    Adams PC, Speechley M, Kertesz AE: Long-term survival analysis in hereditary hemochromatosis. Gastroenterology 101:368–372. 1991Google Scholar
  34. 34.
    Soloway RD, Summerskill WHJ, Baggenstoss AH, Geall MG, Gitnick GL, Elveback LR: Clinical, biochemical, and histological remission of severe chronic active liver disease: A controlled study of treatments and early prognosis. Gastroenterology 63:820–826, 1972Google Scholar
  35. 35.
    McIntyre N, Benhamou JP, Bircher J, Rizzetto M, Rodes J:In Ox Textb Clin Hepatol 2:765–766, 1992Google Scholar
  36. 36.
    Davis G, Czaja A, Ludwig J: Development and prognosis of histologic cirrhosis in corticosteroid-treated hepatitis B surface antigen-negative chronic active hepatitis. Gastoenterology 87:1222–1227, 1984Google Scholar
  37. 37.
    Roll J, Boyer JL, Barry D, Klatkin G: The prognostic importance of clinical and histologic features in asymptomatic and symptomatic primary biliary cirrhosis. N Engl J Med 308:1–7, 1984Google Scholar
  38. 38.
    Beswick D, Klatskin G, Boyer J: Asymptomatic primary biliary cirrhosis. A progress report on long-term follow up and natural history. Gastroenterology 89:267–271, 1985Google Scholar
  39. 39.
    Dickson ER, Grambsch PM, Fleming TR, Fisher LD, Langworthy A: Prognosis in primary biliary cirrhosis: Model of decision making. Hepatology 10:1–7, 1989Google Scholar
  40. 40.
    Christensen E, Neuberger J, Crowe J, Altman D, Popper H, Portmann B: Beneficial effect of azathioprine and prediction of prognosis in primary biliary cirrhosis. Final results of an international trial. Gastroenterology 89:1084–1091, 1985Google Scholar
  41. 41.
    Propst T, Propst A, Dietze O, Judmaier G, Braunsteiner H, Vogel W: High prevalence of viral infection in adults with homozygous and heterozygous alpha1-antitrypsin deficiency and chronic liver disease. Ann Intern Med 117:641–645, 1992Google Scholar
  42. 42.
    Propst T, Propst A, Dietze O, Judmaier G, Braunsteiner H, Vogel W: Risk of hepatocellular carcinoma in alpha1-antitrypsin deficiency. J Hepatol 21:1006–1011, 1994Google Scholar

Copyright information

© Plenum Publishing Corporation 1995

Authors and Affiliations

  • Albert Propst
    • 1
    • 2
  • Theresa Propst
    • 1
    • 2
  • Günther Zangerl
    • 1
    • 2
  • Dietmar Öfner
    • 1
    • 2
  • Gert Judmaier
    • 1
    • 2
  • Wolfgang Vogel
    • 1
    • 2
  1. 1.Department of Surgery/TransplantationUniversity of InnsbruckInnsbruckAustria
  2. 2.Department of Internal Medicine, Gastroenterology DivisionInnsbruck UniversityInnsbruckAustria

Personalised recommendations