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Reuters Health Information (2010-01-01): Alcoholic cirrhosis often complicated from the outset


Alcoholic cirrhosis often complicated from the outset

Last Updated: 2010-01-01 12:00:11 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Patients with alcoholic cirrhosis often present with complications at diagnosis that are strong predictors of death at one year, results of a Danish study indicate.

"Research shows that 76% of patients with alcoholic liver cirrhosis have already developed one or more major complications at the time of cirrhosis diagnosis," Dr. Peter Jepsen from Aarhus University Hospital, wrote in an email to Reuters Health. "These complications increase patients' risk of death, but do not develop in any particular chronological order."

As reported in the December issue of Hepatology, Dr. Jepsen and colleagues studied 466 Danish patients who were diagnosed with alcoholic cirrhosis between 1993 and 2005, following them through August 2006.

The cohort was mostly male (71%) with a median age of 53 years, and most of the patients (79%) consumed alcohol at the time of inclusion.

The investigators examined the prevalence, risk, chronology and mortality associated with ascites, variceal bleeding and hepatic encephalopathy.

They found that 114 patients (24%) had no complications at study entry, while 254 (55%) had ascites alone, 29 (6%) had variceal bleeding alone, 20 (4%) had ascites and variceal bleeding, and 49 (11%) had hepatic encephalopathy alone or with another of these complications.

Among the patients with no complications at baseline, 17% died within 1 year, Dr. Jepsen and colleagues report. Among patients with complications, 1-year mortality was 20% following variceal bleeding alone, 29% following ascites alone, 49% following ascites and variceal bleeding, and 64% following encephalopathy.

While complications did not develop in any predictable sequence, the risk of developing complications for patients without encephalopathy was approximately 25% after 1 year and 50% after 5 years.

For patients without initial complications, the most common first complication was ascites (12% within 1 year), followed by variceal bleeding (6%) and encephalopathy (4%).

Dr. Jepsen told Reuters Health he would like to see clinician-researchers "establish methods to predict whether a particular patient will develop one or the other complication next."

"Such methods will ensure that clinicians can take action to prevent complications in high-risk patients, and at the same time spare low-risk patients from unnecessary interventions," he added.

Hepatology 2009.

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