Long-term prognosis of patients with alcoholic liver cirrhosis: a 15-year follow-up study of 100 Norwegian patients admitted to one unit
Long-term prognosis of patients with alcoholic liver cirrhosis: a 15-year follow-up study of 100 Norwegian patients admitted to one unit
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DOI：
10.1080/00365520410006350
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发表时间：
2004-09-01
影响因子：
1.9
通讯作者：
Sandvik, L
中科院分区：
文献类型：
--
作者：
Bell, H;Jahnsen, J;Sandvik, L
背景资料：大多数酒精性肝硬化患者的随访研究时间为5年或更短，本研究的目的是评估酒精性肝硬化患者的长期死亡率和死亡原因，并确定死亡率的预测因素。研究方法：从1984年5月至1988年12月，100例酒精性肝硬化患者连续入住一个医疗部门，被纳入本研究。所有患者均有数年每日至少100 g乙醇的酒精滥用史。该研究包括65名男性和35名女性，中位年龄为58岁（范围34-82）。对89例患者进行了经皮肝活检和/或尸检。67例患者入院时有腹水，34%有食管静脉曲张出血。对所有患者进行前瞻性随访，直至死亡或直至2000年10月。结果：在随访期间，90%的患者死亡，其中68例（76%）进行了尸检。1、3、6和12个月后的累计精算死亡率分别为18%、28%、36%和49%，5、10和15年后分别为71%、84%和90%。在研究期间，没有患者接受肝移植。90例患者中有52例（58%）的死亡原因是出血、肝功能衰竭或这两种情况的组合，而9例（11%）在纳入研究后0.5至73个月死于肝细胞癌。使用考克斯回归分析，年龄，酗酒和碱性磷酸酶是独立的和显着的预测死亡率，但Child-Pugh分级不是。结论：一组晚期酒精性肝硬化患者的死亡率极高，5年和15年死亡率分别为71%和90%。预后不良的独立预测因素是高龄、每天持续饮酒超过10 g和碱性磷酸酶水平高。
Background: Most follow-up studies in patients with alcoholic liver cirrhosis have been for a 5-year period or less. The aim of this study was to assess the long-term mortality and causes of death among patients with alcoholic liver cirrhosis and to identify predictors of mortality. Methods: One hundred patients with alcoholic liver cirrhosis, consecutively admitted to one medical department, were included in the study from May 1984 until December 1988. All patients had a history of alcohol abuse of at least 100 g ethanol daily for several years. The study comprised 65 men and 35 women with a median age of 58 years (range 34-82). Percutaneous liver biopsies and/or autopsies were obtained on 89 patients. Sixty-seven had ascites at admission and 34% had bleeding oesophageal varices. All patients were followed prospectively until death or until October 2000. Results: During the follow-up period 90% of the patients died, 68 of whom (76 %) had been autopsied. The cumulative actuarial mortality after 1, 3, 6 and 12 months was 18%, 28%, 36% and 49%, respectively and after 5, 10 and 15 years 71%, 84% and 90%, respectively. None of the patients underwent liver transplantation during the study. The causes of death were bleeding, liver failure or a combination of these two conditions in 52 of 90 patients (58%), while 9 (11%) died of hepatocellular carcinoma 0.5 to 73 months after inclusion in the study. Using the Cox regression analysis, age, alcohol abuse and alkaline phosphatase were independent and significant predictors of mortality, but Child-Pugh class was not. Conclusions: The mortality in a group of patients with advanced alcoholic cirrhosis was extremely high with 5 and 15 years' mortality in 71% and 90%, respectively. Independent predictors of a poor prognosis were high age, continuous alcohol consumption of more than 10 g ethanol per day and high levels of alkaline phosphatase.