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Liver Failure/Cirrhosis/Portal Hypertension
Clinical course of alcoholic liver cirrhosis: A Danish population-based cohort study†
Article first published online: 9 DEC 2009
Copyright © 2009 American Association for the Study of Liver Diseases
Volume 51, Issue 5, pages 1675–1682, May 2010
How to Cite
Jepsen, P., Ott, P., Andersen, P. K., Sørensen, H. T. and Vilstrup, H. (2010), Clinical course of alcoholic liver cirrhosis: A Danish population-based cohort study. Hepatology, 51: 1675–1682. doi: 10.1002/hep.23500
Potential conflict of interest: Nothing to report.
- Issue published online: 22 APR 2010
- Article first published online: 9 DEC 2009
- Accepted manuscript online: 9 DEC 2009 12:00AM EST
- Manuscript Accepted: 4 DEC 2009
- Manuscript Received: 30 JUN 2009
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. (HEPATOLOGY 2010.)