Survival and prognostic indicators in patients with hepatitis B virus-related cirrhosis after onset of hepatic decompensation.
OBJECTIVE
To determine the 2-year survival and prognostic indicators of hepatitis B virus-related cirrhosis after the onset of hepatic decompensation.


BACKGROUND
Chronic hepatitis B (CHB) patients with cirrhosis and resultant hepatic decompensation have reduced survival. However, the natural history of these patients has not been well characterized in previous studies. Better understanding of survival and prognostic indicators is essential in management of these patients, especially in determining who should be candidates for orthotopic liver transplantation.


METHODS
This is a retrospective longitudinal study of 96 patients with CHB-related cirrhosis after the onset of hepatic decompensation. The overall survival was ascertained, and clinical and laboratory variables were analyzed. Significant prognostic indicators for survival at 2 years were determined using univariate and multivariate analyses with Cox regression model.


RESULTS
The overall survival was 80% at 2 years after onset of decompensation. With univariate and multivariate analyses, hepatic encephalopathy and hypoalbuminemia less than 2.8 g/dL were significant prognostic indicators of poor survival probability. The hazard ratios were 5.22 (95% confidence interval, 1.67-16.3) and 8.57 (95% confidence interval, 1.94-37.8), respectively. Patients with hypoalbuminemia less than 2.8 g/dL had a 2-year survival of only 62%.


CONCLUSIONS
Our study showed that of CHB patients who developed the first episode of hepatic decompensation, those with hepatic encephalopathy or significant hypoalbuminemia or both have worse prognoses. They should be considered potential candidates for liver transplantation.
Hui
Alex Yui
AY
Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong ROC. alexyhui@hotmail.com
Chan
Henry Lik-yuen
HL
Leung
Nancy Wai-yee
NW
Hung
Lawrence Cheung-tsui
LC
Chan
Francis Ka-leung
FK
Sung
Joseph Jao-yiu
JJ
D005260:Female; D005500:Follow-Up Studies; D006501:Hepatic Encephalopathy / Q000401:mortality; D019694:Hepatitis B, Chronic / Q000401:mortality*; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality* / Q000821:virology; D017093:Liver Failure / Q000401:mortality*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors