Late-stage Presentation with Decompensated Cirrhosis is Alarmingly Common but Successful Etiologic Therapy Allows for Favorable Clinical Outcomes

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2023 Aug 24

PMID 37616205

Authors

Michael Schwarz

Caroline Schwarz

Lukas Burghart

Nikolaus Pfisterer

David Bauer

Wolfgang Hubl

Mattias Mandorfer

Michael Gschwantler

Thomas Reiberger

Affiliations

Soon will be listed here.

Abstract

Introduction: Liver cirrhosis accounts for considerable morbidity and mortality worldwide and late presentation limits therapeutic options. We aimed to assess characteristics of patients with liver cirrhosis at the time of first presentation and during their clinical course.

Methods: Patients with cirrhosis as evident by presence of varices at endoscopy, liver stiffness ≥15kPa at elastography, or ascites requiring paracentesis between Q1/2015-Q2/2020 were retrospectively included. Clinical, laboratory, and imaging data were collected from medical records at presentation and last follow-up.

Results: 476 patients were included (alcohol-related liver disease, ALD: 211, 44.3%; viral hepatitis: 163, 34.2%). Of these, 106 patients (22.3%) and 160 patients (33.6%) presented already with Child-Pugh C and MELD >15, respectively, and decompensation events were registered in 50% (238 patients) at baseline, and even in 75.4% of ALD patients. During a median follow-up of 11.0 (IQR 4-24) months, 116 patients died. Two-year survival was worse for patients with ALD than for viral hepatitis (71.1% vs. 90.2%, log rank p<0.001). We observed the highest percentage of portal-vein thrombosis (30.0%), hepatocellular carcinoma (15.0%), and death (45.0%) in the MAFLD group (n = 20). Patients cured from hepatitis C showed significant improvements in platelet count (147 to 169 G/L, p<0.001) and liver stiffness (26.2 to 17.7 kPa, p<0.001), while ALD patients improved in Child-Pugh score (8.6 to 7.6, p<0.001) during follow-up. With increasing Child Pugh score and MELD, we found increasing serum concentrations of CRP (p<0.001) and an inverse correlation with serum HDL (Spearman's ρ = -0.573 and -0.529, respectively, p<0.001).

Conclusion: Half of the patients with cirrhosis had decompensated cirrhosis at presentation. This calls for increased awareness and strategies for earlier diagnosis of chronic liver disease and cirrhosis.

Citing Articles

Risk factors and prognostic impact of new decompensated events in hospitalized patients with decompensated cirrhosis.

Lan Y, Yu Y, Zhang X, Xu X, Yu X, Tu H BMC Gastroenterol. 2024; 24(1):408.

PMID: 39543468 PMC: 11566372. DOI: 10.1186/s12876-024-03494-3.

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