Natural history of liver cirrhosis in south China based on a large cohort study in one center: a follow-up study for up to 5 years in 920 patients

Abstract

Background: The natural history of liver cirrhosis in China has not been well understood. This study aimed to elucidate the profile and development of the complications of liver cirrhosis as well as the mortality of those cirrhotics with miscellaneous complications.

Methods: We assembled data from the clinical characteristics, especially from the profile complications of cirrhosis on admission, and collected information by telephone or interview with patients and/or their family members in clinic to evaluate the development of complications in 920 patients enrolled in a prospective non-randomized cohort study, and followed up from June 2006 to October 2010. Mortality was calculated using Kaplan-Meier analysis and Cox regress analysis. We employed both of the Child-Pugh scoring system and model for end-stage liver disease (MELD) scoring system to compare with the accordance and veracity between liver function and the long-term outcome.

Results: On admission, only 7.4% patients had no complications, 44.5% patients with one complication (ascites, esophageal/gastric varices or hepatocellular carcinoma), 33.8% patients with two coexisting complications, and 7.5% patients had complications concurrently with ascites, esophageal/gastric varices and hepatocellular carcinoma. During the follow-up (mean follow-up time was 17 months, ranging from 1.0 to 52.2 months) of all the patients, 37.5% patients survived without new complications, 62.5% patients had new complications, and the overall mortality was 53.9%. Patients with one or more complications had higher mortality (total mortality, 1-year or 3-year mortality) and shorter mean survival time than those without any complication; the major cause of mortality of these cirrhotic patients was hepatocellular carcinoma (59%). Evaluated with the Child-Pugh score system, the total mortality in those with the scores more than 12 (class C) was 71.4%, the 1-year and 3-year mortalities were 57.1% and 71.4% respectively; while evaluated with the MELD scoring system, the mortality of those with the scores more than 30 was 58.6%, the 1-year and 3-year mortalities were 44.2% and 57.8% respectively.