Further decompensation in cirrhosis: Results of a large multicenter cohort study supporting Baveno VII statements.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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D'Amico Gennaro, Zipprich Alexander, Villanueva Càndid, Sordà Juan Antonio, Morillas Rosa Maria, Garcovich Matteo, García Retortillo Montserrat, Martinez Javier, Calès Paul, D'Amico Mario, Dollinger Matthias, García-Guix Marta, Gonzalez Ballerga Esteban, Tsochatzis Emmanuel, Cirera Isabel, Albillos Agustìn, Roquin Guillaume, Pasta Linda, Colomo Alan, Daruich Jorge, Canete Nuria, Boursier Jérôme, Dallio Marcello, Gasbarrini Antonio, Iacobellis Angelo, Gobbo Giulia, Merli Manuela, Federico Alessandro, Svegliati Baroni Gianluca, Pozzoni Pietro, Addario Luigi, Chessa Luchino, Ridola Lorenzo, Garcia-Tsao Guadalupe
Аннотация
APPROACH AND RESULTS: Multicenter cohort study. The cumulative incidence of further decompensation (development of a second event or complication of a decompensating event) was assessed using competing risks analysis in 2028 patients. A 4-state model was built: first decompensation, further decompensation, liver transplant, and death. A cause-specific Cox model was used to assess the adjusted effect of further decompensation on mortality. Sensitivity analyses were performed for patients included before or after 1999. In a mean follow-up of 43 months, 1192 patients developed further decompensation and 649 died. Corresponding 5-year cumulative incidences were 52% and 35%, respectively. The cumulative incidences of death and liver transplant after further decompensation were 55% and 9.7%, respectively. The most common further decompensating event was ascites/complications of ascites. Five-year probabilities of state occupation were 24% alive with first decompensation, 21% alive with further decompensation, 7% alive with a liver transplant, 16% dead after first decompensation without further decompensation, 31% dead after further decompensation, and <1% dead after liver transplant. The HR for death after further decompensation, adjusted for known prognostic indicators, was 1.46 (95% CI: 1.23-1.71) ( p <0.001). The significant impact of further decompensation on survival was confirmed in patients included before or after 1999.
CONCLUSIONS: In cirrhosis, further decompensation occurs in ~60% of patients, significantly increases mortality, and should be considered a more advanced stage of decompensated cirrhosis.