Natural history of hepatitis B virus-related cirrhotic patients hospitalized to control ascites.
OBJECTIVE
Few studies have assessed the natural history of hepatitis B virus (HBV)-related cirrhotic ascites. We investigated the natural history of patients with HBV-related cirrhotic ascites hospitalized to control ascites and determined their prognosis, including survival rates and prognostic factors affecting survival.


METHODS
Between January 1996 and December 2005, 203 consecutive patients with HBV-related cirrhotic ascites were followed for a median of 80.7 months (range, 15-149) after their first significant ascitic decompensation that required hospitalization.


RESULTS
The mean age of all patients was 52.6 years. Male gender predominated (male/female, 138/65). A subgroup analysis of 165 patients who had ascitic decompensation as their first episode of hepatic decompensation revealed that gastrointestinal variceal bleeding developed after a median interval of 8 months following ascitic decompensation in 31 (18.8%) patients, hepatic encephalopathy occurred at 9 months in 53 (32.1%), spontaneous bacterial peritonitis appeared at 12.7 months in 24 (14.5%), hepatorenal syndrome occurred at 8.1 months in five (3%), and hepatocellular carcinoma was observed at 21.2 months in 10 (6.1%). The overall median survival was 12.4 months. The 1- and 3-year survival rates were 50.7 and 18.7%. The prognostic factors that independently correlated with survival at the time of ascitic decompensation were Child-Pugh classification B/C (P = 0.030), serum white blood cell (WBC; P = 0.035), serum creatinine (Cr; P = 0.039), serum sodium (Na; P = 0.010), and antiviral therapy (P = 0.040).


CONCLUSIONS
The prognosis of HBV-related cirrhotic patients with ascitic decompensation is poor. Child-Pugh class, serum WBC/Cr/Na, and antiviral therapy primarily influenced survival.
Kim
Seung Up
SU
Department of Internal Medicine, Yonsei University, College of Medicine, Seoul, South Korea.
Han
Kwang-Hyub
KH
Nam
Chung Mo
CM
Park
Jun Yong
JY
Kim
Do Young
DY
Chon
Chae Yoon
CY
Ahn
Sang Hoon
SH
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D001201:Ascites / Q000401:mortality / Q000628:therapy / Q000821:virology*; D006528:Carcinoma, Hepatocellular / Q000821:virology; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D004932:Esophageal and Gastric Varices / Q000821:virology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000821:virology; D006501:Hepatic Encephalopathy / Q000821:virology; D006509:Hepatitis B / Q000150:complications* / Q000401:mortality / Q000628:therapy; D006530:Hepatorenal Syndrome / Q000821:virology; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D007958:Leukocyte Count; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality / Q000628:therapy / Q000821:virology*; D008113:Liver Neoplasms / Q000821:virology; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000382:microbiology / Q000821:virology; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012964:Sodium / Q000097:blood; D013997:Time Factors
D000998:Antiviral Agents; D012964:Sodium; D003404:Creatinine