The Prognosis of Liver Cirrhosis and Ascites in a large General Hospital

Snijder, E. (Eveline) (2017) The Prognosis of Liver Cirrhosis and Ascites in a large General Hospital. thesis, Medicine.

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Abstract

Background: Liver cirrhosis is the end-stage of damage arising from a wide variety of chronic liver diseases. Cirrhosis is one of the twelve leading causes of death in the United States. Liver related deaths are still rising. Ascites is the most common complication of liver cirrhosis. Ascites is defined as the pathologic accumulation of fluid in the peritoneal cavity. Ascites is associated with a poor prognosis and impaired quality of life in patients with cirrhosis. Available studies that investigated the prognosis of liver cirrhosis and ascites to date have two major disadvantages. First, data are derived from tertiary referral centres, thereby decreasing validity and applicability for general hospitals. Second, survival studies on patients with cirrhosis and ascites frequently date several years back. In recent years, several important aspects in the management of liver cirrhosis and ascites have improved. Aim: The aim of this study is to define the current prognosis of patients with cirrhosis and ascites in a large general hospital. Second aim is to identify prognostic factors for survival. Patients and methods: A total of 166 patients (103 men, 63 female, mean age 63 years) were retrospectively investigated. Patients were older then 18 years and were diagnosed with liver cirrhosis and ascites by means of clinical, biochemical and ultrasound features. The following clinical and laboratory variables were evaluated as potential prognostic factors for the probability of survival at the time of new onset ascites: age, gender, aetiology of cirrhosis, Child-Pugh score, MELD score, serum sodium and grade of ascites. The development and treatment of complications were monitored during follow-up and evaluated as potential prognostic factors for the probability of survival during follow-up. A p-value <0,05 was considered significant. The primary end-point was death or transplantation. Results: The median overall survival was 5.2 years (95% CI: 2.4-7.9) after development of ascites. The 1-year overall survival probability was 81%, the 3-year overall survival probability was 71% and the 5-year overall survival probability was 55%. The following variables were independent predictors of mortality at baseline in the multivariate analysis: alcoholic aetiology of cirrhosis, a higher MELD score and the time of first presentation with ascites (p<0.01). The development of the following complications were independent predictors of mortality during follow-up in the multivariate analysis: HRS, HE and the presence of oesophageal varices (p<0.05). Conclusion: In conclusion, in a large general hospital, the prognosis of liver cirrhosis complicated by ascites is much better than mostly reported in the literature with a 5 year survival rate of 55%. At the time of first presentation with ascites, alcoholic aetiology of cirrhosis, a lower MELD score and newly diagnosed liver cirrhosis significantly improves survival. During follow-up after development of ascites, hepatorenal syndrome, hepatic encephalopathy and presence of oesophageal varices negatively impact prognosis.

Item Type:	Thesis (Thesis)
Supervisor name:	BEGELEIDER 1: and Blokzijl, DR. H. and BEGELEIDER 2: and Verdonk, DR. R.C. and ST. ANTONIUSZIEKENHUIS NIEUWEGEIN and AFDELING MAAG-DARM-LEVER ZIEKTEN
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:55
Last Modified:	25 Jun 2020 10:55
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1558

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