Characterization and Determination of Prognostic Factors at the First Episode of Decompensation of Liver Cirrhosis with Ascitis

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Purpose: We aimed at identifying clinical and laboratory indicators of higher mortality at hospital admission and at 1 and 3 years in patients admitted with the first episode of decompensation of liver cirrhosis with ascitis Methods: The records of 131 consecutive patients admitted with ascitis as the first episode of decompensation of liver cirrhosis were analyzed. Patients were followed up till death or study closure date on 31th August 2007. Exploratory Analysis, Mann Whitney, Chi square and Fisher's Exact tests were applied. Significance level: 5% (SPSS version 15). Results: The average age was 58.4 ± 13.5 years with a predominance of male sex –79.4% (104). Average duration of follow up –20.7 ± 28.82 months. Etiology of liver cirrhosis: alcohol –65% (85), alcohol + viral –15.3% (20), viral –15.3% (20), non alcoholic and non viral –4.6% (6). Severe alcoholic hepatitis (Maddrey's discriminant function > 32) was present in 12.5% (16/128) patients. Distribution according to Child Pugh Class: A –2.4% (3/124), B –45.2% (56/124), C 52.4% (65/124). The average MELD score was 15.7 ± 5.9. The prevalence of community acquired infection was 29.3% (36/123) with the following subgroups: Spontaneous bacterial peritonitis (SBP) –16; Urinary tract infection (UTI) –11, pneumonia –4, sepsis –3, soft tissue infection –2. The incidence of nosocomial infection was 14.6% (18/123) with the following subgroups: UTI –9, SBP –3, sepsis –3, pneumonia –2, soft tissue infection –1. The mortality at first hospital admission for decompensated liver cirrhosis was 10.7% (14/117). We did not find any factors significantly associated with mortality at first hospital admission. The mortality at one year was 42.7% (41/96), and that at 3 years 62.5% (50/80). Patients who died at 1 year and 3 years were significantly older (P= 0.03; P= 0.006), and had higher MELD scores (P= 0.012; P= 0.005). Mortality at 1 year was significantly higher in patients aged ≥50 years (P= 0.011), MELD score ≥15 (P= 0.03) and with >2 hospital re-admissions (P= 0.015). Mortality at 3 years was significantly higher in patients aged ≥50 years (P= 0,012). There was no significant association between the sex, aetiology of liver cirrhosis, serum cholesterol, creatinine, sodium levels and presence of infections with the higher mortality. Conclusion: Nearly all the patients who presented with ascitis had advanced liver cirrhosis (Child Pugh B and C). Patients with this form of decompensation of liver cirrhosis have an elevated mortality (65%) at 3 years. Higher age and MELD score ≥15 were significantly associated with mortality at 1 and 3 years.