Different patterns of decompensation in patients with alcoholic vs. non-alcoholic liver cirrhosis
Version of Record online: 24 APR 2012
© 2012 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 35, Issue 12, pages 1443–1450, June 2012
How to Cite
Wiegand, J., Kühne, M., Pradat, P., Mössner, J., Trepo, C. and Tillmann, H. L. (2012), Different patterns of decompensation in patients with alcoholic vs. non-alcoholic liver cirrhosis. Alimentary Pharmacology & Therapeutics, 35: 1443–1450. doi: 10.1111/j.1365-2036.2012.05108.x
- Issue online: 14 MAY 2012
- Version of Record online: 24 APR 2012
- Manuscript Accepted: 3 APR 2012
- Manuscript Revised: 29 MAR 2012
- Manuscript Revised: 24 MAR 2012
- Manuscript Received: 3 MAR 2012
The histological pattern of fibrosis in liver cirrhosis varies in different chronic liver diseases, and hepatic decompensation may be differentiated in consequences of fibrosis (i.e. ascites, variceal bleeding) or in lack of function (i.e. jaundice) resulting in aetiology-specific variable morbidity and mortality.
To evaluate patterns of hepatic decompensation in relation to the aetiology of liver cirrhosis.
Two different cohorts were retrospectively evaluated between 2002 and 2007. Cohort A was for hypothesis generation and consisted of 220 cirrhotic patients. To confirm the initial observations a second cohort B (n = 217) was analysed. The different patterns of hepatic decompensation evaluated were ascites, jaundice, encephalopathy, variceal bleeding, spontaneous bacterial peritonitis, hepatorenal syndrome or hepatocellular carcinoma.
Furthermore, we analysed survival in relation to pattern of decompensation in alcoholic vs. non-alcoholic liver disease.
Alcoholics were more frequently hospitalised for ascites (cohort A: 81.4% vs. 65.4%, P = 0.016; cohort B 71.3% vs. 58.5%, P = 0.085). In contrast, non-alcoholics presented with higher rates of hepatocellular carcinoma (cohort A: 23.1% vs. 11.9%, P = 0.046; cohort B 38.6% vs. 22.5%, P = 0.018). There were no significant differences in jaundice, variceal bleeding, hepatorenal syndrome or encephalopathy.
Survival was significantly impaired in non-alcoholic cirrhosis once ascites occurred (P = 0.003), whereas ascites did not predict higher mortality in patients with alcoholic cirrhosis.
Ascites is the leading initial pattern of decompensation in alcoholic cirrhosis whereas hepatocellular carcinoma dominates in non-alcoholics. Non-alcoholics developing ascites show a poor survival.