Department of Internal Medicine IV, Department for Gastroenterology and Hepatology, Klinik Ottakring, Vienna, Austria.
Department of Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.
PLoS One. 2023 Aug 24;18(8):e0290352. doi: 10.1371/journal.pone.0290352. eCollection 2023.
Liver cirrhosis accounts for considerable morbidity and mortality worldwide and late presentation limits therapeutic options. We aimed to assess characteristics of patients with liver cirrhosis at the time of first presentation and during their clinical course.
Patients with cirrhosis as evident by presence of varices at endoscopy, liver stiffness ≥15kPa at elastography, or ascites requiring paracentesis between Q1/2015-Q2/2020 were retrospectively included. Clinical, laboratory, and imaging data were collected from medical records at presentation and last follow-up.
476 patients were included (alcohol-related liver disease, ALD: 211, 44.3%; viral hepatitis: 163, 34.2%). Of these, 106 patients (22.3%) and 160 patients (33.6%) presented already with Child-Pugh C and MELD >15, respectively, and decompensation events were registered in 50% (238 patients) at baseline, and even in 75.4% of ALD patients. During a median follow-up of 11.0 (IQR 4-24) months, 116 patients died. Two-year survival was worse for patients with ALD than for viral hepatitis (71.1% vs. 90.2%, log rank p<0.001). We observed the highest percentage of portal-vein thrombosis (30.0%), hepatocellular carcinoma (15.0%), and death (45.0%) in the MAFLD group (n = 20). Patients cured from hepatitis C showed significant improvements in platelet count (147 to 169 G/L, p<0.001) and liver stiffness (26.2 to 17.7 kPa, p<0.001), while ALD patients improved in Child-Pugh score (8.6 to 7.6, p<0.001) during follow-up. With increasing Child Pugh score and MELD, we found increasing serum concentrations of CRP (p<0.001) and an inverse correlation with serum HDL (Spearman's ρ = -0.573 and -0.529, respectively, p<0.001).
Half of the patients with cirrhosis had decompensated cirrhosis at presentation. This calls for increased awareness and strategies for earlier diagnosis of chronic liver disease and cirrhosis.
肝硬化在全球范围内导致相当高的发病率和死亡率，而晚期就诊限制了治疗选择。我们旨在评估首次就诊时和临床病程中肝硬化患者的特征。
回顾性纳入 2015 年第一季度至 2020 年第二季度期间内镜检查显示静脉曲张、弹性成像提示肝硬度≥15kPa 或需要经皮穿刺放腹水的肝硬化患者。收集患者就诊时和最后一次随访时的临床、实验室和影像学数据。
共纳入 476 例患者（酒精性肝病，ALD：211 例，44.3%；病毒性肝炎，163 例，34.2%）。其中，106 例（22.3%）和 160 例（33.6%）患者分别在就诊时已经处于 Child-Pugh C 级和 MELD>15，50%（238 例）患者在基线时和甚至 75.4%的 ALD 患者出现失代偿事件。中位随访 11.0（IQR 4-24）个月后，有 116 例患者死亡。ALD 患者的 2 年生存率低于病毒性肝炎患者（71.1% vs. 90.2%，对数秩检验 p<0.001）。在 MAFLD 组（n=20）中，我们观察到门静脉血栓形成（30.0%）、肝细胞癌（15.0%）和死亡（45.0%）的比例最高。丙型肝炎治愈患者的血小板计数（147 至 169 G/L，p<0.001）和肝硬度（26.2 至 17.7 kPa，p<0.001）显著改善，而 ALD 患者的 Child-Pugh 评分（8.6 至 7.6，p<0.001）在随访期间也有所改善。随着 Child-Pugh 评分和 MELD 的增加，我们发现 CRP 血清浓度升高（p<0.001），与血清 HDL 呈负相关（Spearman's ρ=-0.573 和-0.529，p<0.001）。
一半的肝硬化患者就诊时已经处于失代偿期肝硬化。这需要提高对慢性肝病和肝硬化的早期诊断的认识和策略。
