Risk Of Decompensation In Childs A Cirrhosis

Patients who progress to cirrhosis may remain compensation without deterioration in liver function or clinical status, for many years. Fattovich et al. (112) reported outcomes in 384 European patients with compensated cirrhosis (Childs-Turcotte-Pugh score [CTP] <7) caused by CHC. The mean length of follow-up was 5 yr, but some patients were only followed for 6 mo and others for over 12 yr. By actuarial analysis, the risk of decompensation (ascites, variceal bleed, or encephalopathy) was 18% and risk of HCC was 7% (Fig. 5), at 5 yr follow-up (Fig. 5). 13% of the cohort died, with 71% of deaths related to liver disease. Overall survival was 91% at 5 yr, and 79% at 10 yr. Patients who experienced

Years after diagnosis

Fig. 5. Actuarial plot demonstrating risk of developing complications is shown for patients with hepatitis C and compensated cirrhosis. Risk was 18% at 5 yr and approx 35% at 10 yr. (Adapted with permission from ref. 112.)

Years after diagnosis

Fig. 5. Actuarial plot demonstrating risk of developing complications is shown for patients with hepatitis C and compensated cirrhosis. Risk was 18% at 5 yr and approx 35% at 10 yr. (Adapted with permission from ref. 112.)

Fig. 6. Outcomes in cirrhotic patients with hepatitis C are shown. Compensated cirrhotics may enjoy a good survival for up to 10 yr. In contrast, cirrhotics who experience decompensation, manifested by a single complication, have significantly shortened survival. (Adapted with permission from ref. 112.)

Fig. 6. Outcomes in cirrhotic patients with hepatitis C are shown. Compensated cirrhotics may enjoy a good survival for up to 10 yr. In contrast, cirrhotics who experience decompensation, manifested by a single complication, have significantly shortened survival. (Adapted with permission from ref. 112.)

decompensation had markedly diminished survival, compared to those who remained compensated (Fig. 6). Multivariate analysis revealed that the major predictors of poor outcome were bilirubin >17 mmol/L, "hepatic stigmata" on physical examination, age >54 yr, and platelet count <130,000 x 106/L.

Table 4

Annual Risk of Decompensation of Liver Disease, Development of Hepatoma (HCC), or Death in Patients with Compensated (Child's A) Cirrhosis

Table 4

Annual Risk of Decompensation of Liver Disease, Development of Hepatoma (HCC), or Death in Patients with Compensated (Child's A) Cirrhosis

Ref no.

Decompensated

(% patients/yr)

Death

Fattovich (112)

3.6

1.4

2.6

Serfaty (113)

5.0

3.3

4.0

Hu (114)

4.4

2.0

3.6

Khan (115)

6.0

2.4

3.8

Study of a smaller (N = 103), but similar cohort of patients, followed for a mean of 40 mo (range 6-72 mo), revealed a 25% risk of decompensation and 11% risk of HCC (113). 16% of patients had died by 4 yr follow-up. Multivariate analysis indicated that low albumin and absence of prior treatment with interferon were the major independent predictors of poor outcome.

Hu and Tong (114) reported results in 112 patients, followed for a mean of 4.5 yr (range 2-7.7 yr). Decompensated occurred in 22.2%, and HCC in 10.1%. They estimated the yearly incidence of decompensation at 4.4%/yr, and risk of HCC at 2.0%/yr. Once patients deteriorated, survival diminished dramatically, from a baseline 5-yr survival of 82.8%, to a survival of 51.5% after decompensation. Survival was poorer in patients with age >55 yr, history of transfusion, albumin <3.5 g/dL, platelets <130,000 x 106/L, and viral load >1 x 106 vEq/mL. One additional series (115) highlighted outcome in 91 cirrhotics with compensation disease, and found that the risk of decompensation was approx 30%, and risk of HCC, 12%, at 5-yr of follow-up. 19% of the cohort either received a liver transplant or died by 5 yr.

In a patient with Child's class A cirrhosis, the overall risk of decompensation ranges from 3.6 to 6.0%/yr, the risk of HCC ranges from 1.4 to 3.3%/yr, and risk of death ranges from 2.6 to 4.0%/yr (Table 4).

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