Prognostic indicators of survival in patients with compensated and decompensated cirrhosis

Abstract

Background/aims: Patients with cirrhosis are classified in a compensated and a decompensated stage. Portal hypertension is responsible for most of the complications of cirrhosis that mark the transition from compensated to decompensated cirrhosis. The objectives of this study were (a) to analyse survival of the different stages and substages of cirrhosis and (b) to examine the prognostic value of the hepatic venous pressure gradient (HVPG) at each of the stages.

Methods: A total of 729 patients with suspected cirrhosis underwent routine measurement of portal pressure and systemic haemodynamics between 11/1995 and 12/2004. The primary end-point of the study was death, collected until November 30th, 2006. Multivariable analysis was performed using two models to determine predictors of death at each stage.

Results: A total of 443 patients were included in the study. The 1-year mortality was 5.4% in compensated and 20.2% in decompensated patients. Compensated patients in stage 1 (no varices) had a longer survival than stage 2 patients (varices present) (P = 0.015). In decompensated patients, survival was not different between stage 3 (ascites, with or without varices) and stage 4 (variceal haemorrhage, with or without ascites). Age and HVPG (cut-off 10 mmHg) were independent predictors of death in compensated patients, whereas MELD was in decompensated patients.

Conclusion: Survival rates and predictors of death are different between patients with compensated and decompensated cirrhosis. Unlike the Italian cohort staging system, ascites is a better stratifying clinical event than variceal haemorrhage in patients with decompensated cirrhosis. The presence of clinically significant portal hypertension has prognostic value in compensated cirrhosis.

Fig. 1

Flow chart of the patients.

Fig. 2

Kaplan–Meier survival curves according to the different stages (stage 1 = compensated, no varices; stage 2 = compensated, varices present; stage 3 = ascites/with or without varices; stage 4 = variceal haemorrhage/with or without ascites).

Fig. 3

Kaplan–Meier survival curves of decompensated patients separated by the presence of ascites. The upper curve belongs to decompensated patients with variceal haemorrhage without ascites, the lower curve to decompensated patients with ascites with or without variceal haemorrhage.

Fig. 4

Kaplan–Meier survival curves of compensated patients divided by hepatic venous pressure gradient at a cut-off of 10 mmHg.