Natural history of compensated viral B and D cirrhosis.
OBJECTIVE
The aim of this study was to define the natural long-term course of HDV compensated cirrhosis.


METHODS
166 consecutive patients with compensated HDV-related cirrhosis diagnosed since 1994 were followed up until the first decompensation and then until death, liver transplantation or 31st of December 2004. The survival during follow-up and the survival according to the type of first decompensation were calculated using the Kaplan Meier method. Survival curves were compared using the log-rank test.


RESULTS
56 females (33.7%) and 110 males (66.3%) with a mean age of 40.7+/-7.9 years were included in the study. The mean Child Pugh and MELD score at the first episode of hepatic decompensation was 8.6+/-2.08 and 15.19+/-5.42, respectively. The median survival was 58.3 months since the diagnosis of compensated cirrhosis and the mean time to first decompensation was 21+/-19 months. The probability of survival after the diagnosis of compensated cirrhosis was 94.3%, 82.5%, and 51.5% at 1, 2, and 5 years, respectively. Ascites was the most frequent first decompensation (80.7%), followed by jaundice (30.1%), portal hypertensive gastrointestinal bleeding (PHGIB) (28.9%), hepatic encephalopathy (HE) (12%), hepatocellular carcinoma (HCC) (12%), portal vein thrombosis (8.4%), spontaneous bacterial peritonitis (SBP), hepatorenal syndrome. 86 patients (51.8%) presented more than one complication at initial decompensation. Survival was worse in patients with jaundice and SBP (p=0.001), followed by patients with HE (p=0.05) and patients who presented more than one initial complication (p=0.03). In the multivariate survival analysis only PHGIB as first decompensation and MELD score>15 were independent predictors of death.


CONCLUSIONS
HDV-related cirrhosis in Romania is an aggressive disease with a median time to decompensation less than 2 years and a median survival less than 5 years. Jaundice, the main clinical consequences of portal hypertension and HCC are the most frequent causes of decompensation and more than half the patients present two or more concomitant initial complications.
Gheorghe
Liana
L
Hepatology Unit, Center of Gastroenterology and Hepatology, Fundeni Clinical Institute, Str. Fundeni no. 258, 72437 Bucharest, Romania. drgheorghe@xnet.ro
Iacob
Speranta
S
Simionov
Iulia
I
Vadan
Roxana
R
Gheorghe
Cristian
C
Iacob
Razvan
R
Parvulescu
Iulia
I
Constantinescu
Ileana
I
D000293:Adolescent; D000328:Adult; D000368:Aged; D004279:DNA, Viral / Q000032:analysis; D018450:Disease Progression; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000150:complications* / Q000821:virology; D006511:Hepatitis B Antigens / Q000276:immunology; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology; D003699:Hepatitis D / Q000150:complications* / Q000821:virology; D003698:Hepatitis Delta Virus / Q000235:genetics / Q000276:immunology; D035923:Hepatitis delta Antigens / Q000276:immunology; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
D004279:DNA, Viral; D006511:Hepatitis B Antigens; D035923:Hepatitis delta Antigens