Multiple cirrhosis-associated decompensating events identified five prognostic disease stages that significantly increased patients’ risk for mortality in a recent study.
Among a cohort of 494 patients (mean age, 50.9 years; 59.7% men) diagnosed with cirrhosis between June 1981 and June 1984, researchers determined that ascites, bleeding, encephalopathy or jaundice were related to five prognostic stages that increased mortality risk. Stages included compensated cirrhosis with and without esophagogastric varices, uncomplicated bleeding, initial nonbleeding decompensations, and any secondary decompensating events.
The cohort included patients with compensated (n=377) and decompensated cirrhosis (n=117); the majority were diagnosed with hepatitis C virus infection (n=404). The mean follow-up was 145 months without patient dropouts.
During the study, 202 patients entered prognostic stage 1; 216 entered stage 2; 75 entered stage 3; 206 moved into stage 4; and 213 advanced to stage 5. A 5-year transition rate toward a different stage was observed in stages 1 to 4 (P<.0001). Five-year mortality advanced through stages 1 to 5 from 1.5%, 10%, 20%, 30% and 88%, respectively (P<.0001).
Patients experienced 380 deaths; 326 esophagogastric varices; 283 ascites; 158 bleeding events; 146 encephalopathy; 113 jaundice; 126 hepatocellular carcinoma cases; and 19 liver transplantations.
Analyses showed that decompensation occurred before mortality in 58% of patients with compensated cirrhosis (10% before decompensation and 4% at the first decompensating event). Survival was significantly better in patients with compensated vs. decompensated cirrhosis at diagnosis.
The study suggests “…a new perspective which better explains the different outcome of compensated and decompensated cirrhosis and shows that five prognostic stages may contribute to improve the disease outcome prediction,” the researchers wrote. “The marked difference in outcome across stages suggests that prognostic indicators should be assessed separately per each disease stage.”
Disclosure: The researchers report no relevant financial disclosures.