Survival of patients with alcoholic and cryptogenic cirrhosis without liver transplantation: a single center retrospective study
Tóm tắt
There is no recent data addressing the long term survival of cirrhosis patients without transplantation, but with the availability of optimal pharmacological and endoscopic therapies. We compared the long term transplant free survival of alcoholic (AC) and cryptogenic (CC) cirrhosis patients in a setting where liver transplantation was, until very recently, not available. AC and CC patient details were extracted from our database, maintained since 1995. For those who had not attended clinics within the past 4 weeks, the patient or families were contacted to obtain survival status. If deceased, cause of death was ascertained from death certificates and patient records. Survival was compared using Kaplan-Meier curves. Complete details were available in 549/651 (84.3%) patients (AC 306, CC 243). Mean follow up duration (SD) (months) was 29.9 (32.6). 82/96 deaths (85.4%) among AC and 80/94 deaths (85.1%) among CC were liver related. Multivariate analysis showed age at diagnosis and Child’s class predicted overall survival among all groups. The median survival in Child’s class B and C were 53.5 and 25.3 months respectively. Survival was similar among AC and CC. Among AC survival was improved by abstinence [HR = 0.63 (95% CI: 0.40-1.00)] and was worse with diabetes [HR=1.59 (95% CI: 1.02- 2.48)] irrespective of alcohol status. The overall survival of AC was similar to CC. Death in both groups were predominantly liver related, and was predicated by age at diagnosis and Child class. Among AC, presence of diabetes and non-abstinence from alcohol were independent predictors for poor survival.
Tài liệu tham khảo
Fleming KM, Aithal GP, Card TR, West J: The rate of decompensation and clinical progression of disease in people with cirrhosis: a cohort study. Aliment Pharmacol Ther. 2010, 32: 1343-1350. 10.1111/j.1365-2036.2010.04473.x.
Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R: Transection of the oesophagus for bleeding esophageal varicies. Br J Surg. 1973, 60: 646-649. 10.1002/bjs.1800600817.
Schuppan D, Afdhal NH: Liver cirrhosis. Lancet. 2008, 371: 838-851. 10.1016/S0140-6736(08)60383-9.
Stokkeland K, Brandt L, Ekbom A, Hultcrantz R: Improved prognosis for patients hospitalized with esophageal varices in Sweden 1969–2002. Hepatology. 2006, 43: 500-505. 10.1002/hep.21089.
Alvarez MA, Cirera I, Solà R, Bargalló A, Morillas RM, Planas R: Long-term Clinical Course of Decompensated Alcoholic Cirrhosis: A Prospective Study of 165 Patients. J Clin Gastroenterol. 2011, 45 (10): 906-911. 10.1097/MCG.0b013e3182284e13.
Kim WR, Therneau TM, Benson JT, Kremers WK, Rosen CB, Gores GJ, et al: Deaths on the liver transplant waiting list: An analysis of competing risks. Hepatology. 2006, 43: 345-351. 10.1002/hep.21025.
Cadahía V, González-Diéguez ML, Alonso P, García-Bernardo C, Miyar de León A, Barneo L, Vázquez L, González-Pinto IM, Rodríguez M: Exclusions and deaths on the liver transplant waiting list. Transplant Proc. 2010, 42 (2): 622-624. 10.1016/j.transproceed.2010.02.009.
Jepsen P, Ott P, Andersen PK, Sorenson HT, Vilstrup H: Clinical course of alcoholic liver cirrhosis: A Danish population-based cohort study. Hepatology. 2010, 51 (5): 1675-1682. 10.1002/hep.23500.
Siang SC, Hai TC: Decompensated cryptogenic and alcoholic cirrhosis in Singapore. A clinical study of 100 patients. Singapore Med J. 1965, 6 (4): 207-212.
Stone WD, Islam NRK, Paton A: The natural history of cirrhosis. Q J Med. 1968, 37: 119-132.
Saunders JB, Walters JR, Davies AP, Paton A: A 20-year prospective study of cirrhosis. Br Med J (Clin Res Ed). 1981, 282 (6260): 263-266. 10.1136/bmj.282.6260.263.
Tanaka R, Itoshima T, Nagashima H: Follow-up study of 582 liver cirrhosis patients for 26 years in Japan. Liver. 1987, 7 (6): 316-324.
Serra MA, Escudero A, Rodríguez F, del Olmo JA, Rodrigo JM: Effect of hepatitis C virus infection and abstinence from alcohol on survival in patients with alcoholic cirrhosis. J Clin Gastroenterol. 2003, 36 (2): 170-174. 10.1097/00004836-200302000-00016.
Bell H, Jahnsen J, Kittang E, Raknerud N, Sandvik L: Long-term prognosis of patients with alcoholic liver cirrhosis: a 15-year follow-up study of 100 Norwegian patients admitted to one unit. Scand J Gastroenterol. 2004, 39 (9): 858-863. 10.1080/00365520410006350.
Toshikuni N, Izumi A, Nishino K, Inada N, Sakanoue R, Yamato R, et al: Comparison of outcomes between patients with alcoholic cirrhosis and those with hepatitis C virus-related cirrhosis. J Gastroenterol Hepatol. 2009, 24 (7): 1276-1283. 10.1111/j.1440-1746.2009.05851.x.
Poonawala A, Nair SP, Thuluvath PJ: Prevalence of obesity and diabetes in patients with cryptogenic cirrhosis: a case–control study. Hepatology. 2000, 32 (4 Pt 1): 689-692.
Caldwell SH, Oelsner DH, Iezzoni JC, Hespenheide EE, Battle EH, Driscoll CJ: Cryptogenic cirrhosis: clinical characterization and risk factors for underlying disease. Hepatology. 1999, 29 (3): 664-669. 10.1002/hep.510290347.
Kojima H, Sakurai S, Matsumura M, Umemoto N, Uemura M, Morimoto H, et al: Cryptogenic cirrhosis in the region where obesity is not prevalent. World J Gastroenterol. 2006, 12 (13): 2080-2085.
Chitturi S, Wong VW, Farrell G: Nonalcoholic fatty liver in Asia: Firmly entrenched and rapidly gaining ground. J Gastroenterol Hepatol. 2011, 26 (Suppl 1): 163-172.
Wijewardene K, Mohideen MR, Mendis S, Fernando DS, Kulathilaka T, Weerasekara D, Uluwitta P: Prevalence of hypertension, diabetes and obesity: baseline findings of a population based survey in four provinces in Sri Lanka. Ceylon Med J. 2005, 50 (2): 62-70.
Misra IA, Pandey RM, Devi JR, Sharma R, Vikram NK, Khanna N: High prevalence of diabetes, obesity and dyslipidaemia in urban slum population in northern India. Int J Obes. 2001, 25: 1722-1729. 10.1038/sj.ijo.0801748.
Buyse S, Valla D: Carbohydrate metabolism dysregulation in cirrhosis: pathophysiology, prognostic impact and therapeutic implications. Gastroenterol Clin Biol. 2007, 31 (3): 266-273. 10.1016/S0399-8320(07)89371-7.
García-Compean D, Jaquez-Quintana JO, Maldonado-Garza H: Hepatogenous diabetes. Current views of an ancient problem. Ann Hepatol. 2009, 8 (1): 13-20.
Bianchi G, Marchesini G, Zoli M, Bugianesi E, Fabbri A, Pisi E: Prognostic significance of diabetes in patients with cirrhosis. Hepatology. 1994, 20 (1 Pt 1): 119-125.
Moreau R, Delègue P, Pessione F, Hillaire S, Durand F, Lebrec D, Valla DC: Clinical characteristics and outcome of patients with cirrhosis and refractory ascites. Liver Int. 2004, 24 (5): 457-464. 10.1111/j.1478-3231.2004.0991.x.
Hickman IJ, Macdonald GA: Impact of diabetes on the severity of liver disease. Am J Med. 2007, 120 (10): 829-834. 10.1016/j.amjmed.2007.03.025.
Nishida T, Tsuji S, Tsujii M, Arimitsu S, Haruna Y, Imano E, et al: Oral glucose tolerance test predicts prognosis of patients with liver cirrhosis. Am J Gastroenterol. 2006, 101 (1): 70-75. 10.1111/j.1572-0241.2005.00307.x.
Hagel S, Bruns T, Herrmann A, Stallmach A, Schmidt C: Abnormal glucose tolerance: a predictor of 30-day mortality in patients with decompensated liver cirrhosis. Z Gastroenterol. 2011, 49 (3): 331-334. 10.1055/s-0029-1245933.
Chen YW, Chen HH, Wang TE, Chang CW, Chang CW, et al: The dissociation between the diabetes and both Child–Pugh score and in-hospital mortality in cirrhotic patients due to hepatitis B, hepatitis C, or alcoholic. Hepatology International. 2011, 5 (4): 955-964. 10.1007/s12072-011-9274-y.
Wiesner R, Edwards E, Freeman R, Harper A, Kim R, Kamath P, et al: Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology. 2003, 124: 91-96. 10.1053/gast.2003.50016.
Heuman D, Mihas A: Utility of the MELD score for assessing 3-month survival in patients with liver cirrhosis: one more positive answer. Gastroenterology. 2003, 125 (3): 992-993. 10.1016/S0016-5085(03)01149-1.