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Clinical course of alcoholic liver cirrhosis: a Danish population-based cohort study.
Hepatology. 2010 May; 51(5):1675-82.Hep

Abstract

The clinical course of alcoholic cirrhosis, a condition with a high mortality, has not been well described. We examined prevalence, risk, chronology, and mortality associated with three complications of cirrhosis: ascites, variceal bleeding, and hepatic encephalopathy. We followed a population-based cohort of 466 Danish patients diagnosed with alcoholic cirrhosis in 1993-2005, starting from the date of hospital diagnosis and ending in August 2006. Data were extracted from medical charts during the follow-up period. Risk and mortality associated with complications were calculated using competing-risks methods. At diagnosis of alcoholic cirrhosis, 24% of patients had no complications, 55% had ascites alone, 6% had variceal bleeding alone, 4% had ascites and variceal bleeding, and 11% had hepatic encephalopathy. One-year mortality was 17% among patients with no initial complications, 20% following variceal bleeding alone, 29% following ascites alone, 49% following ascites and variceal bleeding (from the onset of the later of the two complications), and 64% following hepatic encephalopathy. Five-year mortality ranged from 58% to 85%. The risk of complications was about 25% after 1 year and 50% after 5 years for all patients without hepatic encephalopathy. The complications under study did not develop in any predictable sequence. Although patients initially without complications usually developed ascites first (12% within 1 year), many developed either variceal bleeding first (6% within 1 year) or hepatic encephalopathy first (4% within 1 year). Subsequent complications occurred in an unpredictable order among patients with ascites or variceal bleeding.

CONCLUSION

Patients with alcoholic cirrhosis had a high prevalence of complications at the time of cirrhosis diagnosis. The presence and type of complications at diagnosis were predictors of mortality, but not of the risk of subsequent complications.

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Authors+Show Affiliations

Jepsen P
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. pj@dce.au.dk
Ott P
No affiliation info available
Andersen PK
No affiliation info available
Sørensen HT
No affiliation info available
Vilstrup H
No affiliation info available

MeSH

AdultAgedAged, 80 and overAscitesCohort StudiesDenmarkEsophageal and Gastric VaricesFemaleGastrointestinal HemorrhageHepatic EncephalopathyHumansLiver Cirrhosis, AlcoholicMaleMiddle AgedPrevalenceTreatment Outcome

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20186844

Citation

Jepsen, Peter, et al. "Clinical Course of Alcoholic Liver Cirrhosis: a Danish Population-based Cohort Study." Hepatology (Baltimore, Md.), vol. 51, no. 5, 2010, pp. 1675-82.
Jepsen P, Ott P, Andersen PK, et al. Clinical course of alcoholic liver cirrhosis: a Danish population-based cohort study. Hepatology. 2010;51(5):1675-82.
Jepsen, P., Ott, P., Andersen, P. K., Sørensen, H. T., & Vilstrup, H. (2010). Clinical course of alcoholic liver cirrhosis: a Danish population-based cohort study. Hepatology (Baltimore, Md.), 51(5), 1675-82. https://doi.org/10.1002/hep.23500
Jepsen P, et al. Clinical Course of Alcoholic Liver Cirrhosis: a Danish Population-based Cohort Study. Hepatology. 2010;51(5):1675-82. PubMed PMID: 20186844.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical course of alcoholic liver cirrhosis: a Danish population-based cohort study. AU - Jepsen,Peter, AU - Ott,Peter, AU - Andersen,Per Kragh, AU - Sørensen,Henrik Toft, AU - Vilstrup,Hendrik, PY - 2010/2/27/entrez PY - 2010/2/27/pubmed PY - 2010/5/15/medline SP - 1675 EP - 82 JF - Hepatology (Baltimore, Md.) JO - Hepatology VL - 51 IS - 5 N2 - UNLABELLED: The clinical course of alcoholic cirrhosis, a condition with a high mortality, has not been well described. We examined prevalence, risk, chronology, and mortality associated with three complications of cirrhosis: ascites, variceal bleeding, and hepatic encephalopathy. We followed a population-based cohort of 466 Danish patients diagnosed with alcoholic cirrhosis in 1993-2005, starting from the date of hospital diagnosis and ending in August 2006. Data were extracted from medical charts during the follow-up period. Risk and mortality associated with complications were calculated using competing-risks methods. At diagnosis of alcoholic cirrhosis, 24% of patients had no complications, 55% had ascites alone, 6% had variceal bleeding alone, 4% had ascites and variceal bleeding, and 11% had hepatic encephalopathy. One-year mortality was 17% among patients with no initial complications, 20% following variceal bleeding alone, 29% following ascites alone, 49% following ascites and variceal bleeding (from the onset of the later of the two complications), and 64% following hepatic encephalopathy. Five-year mortality ranged from 58% to 85%. The risk of complications was about 25% after 1 year and 50% after 5 years for all patients without hepatic encephalopathy. The complications under study did not develop in any predictable sequence. Although patients initially without complications usually developed ascites first (12% within 1 year), many developed either variceal bleeding first (6% within 1 year) or hepatic encephalopathy first (4% within 1 year). Subsequent complications occurred in an unpredictable order among patients with ascites or variceal bleeding. CONCLUSION: Patients with alcoholic cirrhosis had a high prevalence of complications at the time of cirrhosis diagnosis. The presence and type of complications at diagnosis were predictors of mortality, but not of the risk of subsequent complications. SN - 1527-3350 UR - https://www.unboundmedicine.com/medline/citation/20186844/Clinical_course_of_alcoholic_liver_cirrhosis:_a_Danish_population_based_cohort_study_ L2 - https://doi.org/10.1002/hep.23500 DB - PRIME DP - Unbound Medicine ER -