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Course of disease and survival after onset of decompensation in hepatitis B virus-related cirrhosis

机译：乙肝病毒相关性肝硬化失代偿期发病后的病程和生存

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Background: Data regarding the outcome of hepatitis B virus (HBV)-related cirrhosis after the onset of decompensation is scanty. Method: From January 1998 to December 2008, a retrospective-prospective inception cohort study involving HBV-related decompensated cirrhotics was performed. Predictors of death and clinical events after the onset of decompensation were evaluated. Patients with co-infection with hepatitis C virus and/or human immunodeficiency virus, alcohol consumption to any degree and diabetes diagnosed before the detection of liver disease were excluded. Result and analysis: Two hundred and fifty-three patients (231 males, 139 e-negative), including 102 untreated patients, were analysed. The mean (±SD) age was 43.0 (±12.0) years. The mean (±SD) follow-up period was 47 (±47) months. Decompensation was the first presentation of liver disease in 210 (83%) patients. Ascites (70%) and variceal bleed (28%) were predominant modes of decompensation. Forty-three (17%) patients died (22 vs 14% in untreated and treated cohort, respectively; P=0.002). Type 2 hepato-renal syndrome was the commonest cause of death (32%). Survival was independent of e-antigen status. In the total cohorts, predictors of death were occurrence of sepsis with systemic inflammatory response (SIRS), ascites as the initial mode of decompensation, absence of antiviral therapy and events of high-grade hepatic encephalopathy [hazards ratios (HR) of 4.4, 3.6, 2.2 and 1.7 respectively]. In the untreated cohort, initial decompensation with ascites and development of sepsis with SIRS were independent predictors of death (HR 8.5 and 2.3 respectively), while 5-year survival was higher in patients having initial decompensation with variceal bleed vs ascites (29 vs 16%, respectively, P=0.002). Conclusion: Decompensation with ascites and sepsis with SIRS predict reduced survival. Antiviral therapy beyond 6 months improves outcome.
机译：背景：代偿失调发作后有关乙型肝炎病毒（HBV）相关性肝硬化结局的数据很少。方法：从1998年1月至2008年12月，进行了一项回顾性前瞻性队列研究，涉及HBV相关的代偿性肝硬化。评估失代偿发作后的死亡和临床事件的预测因素。排除患有丙型肝炎病毒和/或人类免疫缺陷病毒的合并感染，任何程度的饮酒和在检测到肝病之前诊断出的糖尿病的患者。结果与分析：分析了253例患者（男231例，e阴性139例），其中102例未经治疗。平均（±SD）年龄为43.0（±12.0）岁。平均（±SD）随访期为47（±47）个月。代偿失调是210（83％）位患者中肝脏疾病的首例表现。腹水（70％）和静脉曲张出血（28％）是失代偿的主要方式。四十三（17％）例患者死亡（未治疗组和治疗组分别为22％和14％; P = 0.002）。 2型肝肾综合征是最常见的死亡原因（32％）。生存与电子抗原状态无关。在所有队列中，死亡的预测因素是发生败血症并伴有全身性炎症反应（SIRS），腹水为失代偿的初始方式，缺乏抗病毒治疗以及高级别肝性脑病的发生[危险比（HR）分别为4.4、3.6 ，分别为2.2和1.7]。在未经治疗的队列中，腹水的初始失代偿和SIRS败血症的发展是死亡的独立预测因子（分别为HR和8.5），而静脉曲张出血初始失代偿的患者的5年生存率高于腹水（29％vs 16％）。 ，分别为P = 0.002）。结论：腹水代偿失调和SIRS败血症预示生存率降低。超过6个月的抗病毒治疗可改善结局。

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