Department of Gastroenterology, Oslo University Hospital, Oslo, Norway.
Department of Public Health, Oslo Metropolitan University, Oslo, Norway.
PLoS One. 2020 Mar 12;15(3):e0230263. doi: 10.1371/journal.pone.0230263. eCollection 2020.
BACKGROUND & AIMS: The prognostic role of gender in patients with liver cirrhosis is not fully understood. Our primary aim was to assess how gender affects cumulative incidence and risk of death without liver transplantation (LT) in cirrhotic patients with gastroesophageal varices. Secondary aims were to assess the relationship between gender and cause specific death, risk of variceal bleeding and incidence rates of gastroesophageal varices in patients with cirrhosis.
All new patients with gastroesophageal varices due to liver cirrhosis at Oslo University Hospital between 2006 and May 2016 were identified. Clinical data were retrieved retrospectively from hospital files. Causes of death were classified according to a specified protocol in cases of in-hospital-death, otherwise by data from the Norwegian Death Registry. Competing risk analyses were used to calculate cumulative incidences and risks of i) all-cause death, ii) cause-specific death and iii) variceal bleeding or re-bleeding.
Cumulative one- and five years incidence of death without LT in 266 included patients were 28% and 51%, respectively. In univariate analysis, risk of death was positively associated with age, Child Pugh class, alcoholic liver disease and presentation with variceal bleeding, and negatively associated with female sex. In a multivariate model, risk of death without LT was associated with female sex (SHR 0.59 [0.40-0.86]), age (SHR 1.05 [1.04-1.07] per year), Child Pugh class B (SHR 1.54 [1.03-2.32]) and Child Pugh class C (SHR 4.29 [2.57-7.17]). Variceal bleeding caused 27% of deaths. Adjusting for age and Child Pugh score, a trend towards reduced risk of death due to variceal bleeding was seen in women (SHR 0.53; [0.26-1.06]). High alcohol consumption was associated with increased risk of first variceal bleeding, both at univariate analysis (SHR 7.73 [1.71-34.9]) and multivariate analysis (SHR 13.9 [2.51-77.0]).
Reduced mortality due to variceal bleeding may contribute to improved survival without LT in cirrhotic women with gastroesophageal varices.
在肝硬化患者中，性别对预后的影响尚不完全清楚。我们的主要目的是评估性别如何影响肝硬化合并胃食管静脉曲张患者无肝移植（LT）累积死亡率和死亡率。次要目的是评估性别与特定原因死亡、静脉曲张出血风险和肝硬化患者胃食管静脉曲张发生率之间的关系。
我们在 2006 年至 2016 年 5 月期间，在奥斯陆大学医院确定了所有新诊断为肝硬化合并胃食管静脉曲张的患者。临床数据通过回顾性病历检索获得。在院内死亡的情况下，根据特定方案对死亡原因进行分类，否则根据挪威死亡登记处的数据进行分类。使用竞争风险分析来计算无 LT 的全因死亡、特定原因死亡和静脉曲张出血或再出血的累积发生率和风险。
266 例纳入患者的 1 年和 5 年累积死亡率分别为 28%和 51%。在单因素分析中，死亡风险与年龄、Child Pugh 分级、酒精性肝病和静脉曲张出血表现呈正相关，与女性性别呈负相关。在多因素模型中，无 LT 死亡风险与女性性别相关（SHR 0.59 [0.40-0.86]）、年龄（SHR 1.05 [1.04-1.07]每年）、Child Pugh 分级 B（SHR 1.54 [1.03-2.32]）和 Child Pugh 分级 C（SHR 4.29 [2.57-7.17]）。静脉曲张出血导致 27%的死亡。在校正年龄和 Child Pugh 评分后，女性死于静脉曲张出血的风险呈降低趋势（SHR 0.53；[0.26-1.06]）。高酒精摄入量与初次静脉曲张出血的风险增加相关，无论是在单因素分析（SHR 7.73 [1.71-34.9]）还是多因素分析（SHR 13.9 [2.51-77.0]）中。
由于静脉曲张出血导致的死亡率降低可能是肝硬化合并胃食管静脉曲张女性患者无 LT 生存率提高的原因之一。
