title: Natural history of compensated viral B and D cirrhosis.
abstract: 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.
authors.affiliation: Hepatology Unit, Center of Gastroenterology and Hepatology, Fundeni Clinical Institute, Str. Fundeni no. 258, 72437 Bucharest, Romania. drgheorghe@xnet.ro
authors.forename: Liana
authors.initials: L
authors.lastname: Gheorghe
authors.forename: Speranta
authors.initials: S
authors.lastname: Iacob
authors.forename: Iulia
authors.initials: I
authors.lastname: Simionov
authors.forename: Roxana
authors.initials: R
authors.lastname: Vadan
authors.forename: Cristian
authors.initials: C
authors.lastname: Gheorghe
authors.forename: Razvan
authors.initials: R
authors.lastname: Iacob
authors.forename: Iulia
authors.initials: I
authors.lastname: Parvulescu
authors.forename: Ileana
authors.initials: I
authors.lastname: Constantinescu
mesh_terms: 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
chemical_list: D004279:DNA, Viral; D006511:Hepatitis B Antigens; D035923:Hepatitis delta Antigens