title: The natural history of hepatitis B virus cirrhosis after the first hepatic decompensation in Tunisia.
abstract: OBJECTIVE
  To define the natural long term course of viral B cirrhosis after the onset of hepatic decompensation and to determine the predictive factors of death.
  
  
  METHODS
  Retrospective longitudinal study including 77 cases of viral B cirrhosis among 192 consecutive patients with cirrhosis, hospitalized between 1997 and 2005 for the first hepatic decompensation. All those patients were followed- up until death or until December 2006. The probability of survival after the first hepatic decompensation was calculated using the Kaplan Meier method. The predictive factors of death were determined through univariate and multivariate analyses with the Cox regression model.
  
  
  RESULTS
  Fifty four men and 23 women with an average age of 54±14.9 years were hospitalized for the first decompensation of the viral B cirrhosis. The 77 patients had been under observation for an average period of 24.2 ±21.1 months. During that time 64% among them died. The probability of survival after decompensation was 47% in 2 years and 22 % in 5 years. During follow- up, ascites was the most frequent decompensation (85%) followed by hepatic encephalopathy (38 %), variceal hemorrhage (34 %), jaundice (30%), hepato renal syndrome (27%), hepatocellular carcinoma (21%), and spontaneous bacterial peritonitis (14%). At univariate analysis four factors were predictive of death: Child Pugh C score (p=0.009), hepatocellular carcinoma (p=0.01), rate of serum gammaglobulin superior to18g / l (p=0.008) and prothrombin time inferior to 50 % (p=0.02). According to the multivariate analysis only the rate of serum gammaglobulin superior to 18g /l was an independent predictive factor of mortality (p=0,001) with IC (95 %) [1.623 - 5.88].
  
  
  CONCLUSIONS
  In Tunisia, the prognosis of viral B cirrhosis after the first decompensation is bad, because a patient on 5 only was able to survive beyond 5 years. Ascites is the most frequent decompensation. Only the rate of serum gammaglobulin superior to 18g / l is an independent predictive factor of mortality.
authors.affiliation: CHU Sahloul, Sousse, Tunisie.
authors.forename: Ali
authors.initials: A
authors.lastname: Jmaa
authors.forename: Mehdi
authors.initials: M
authors.lastname: Ksiaa
authors.forename: Aida
authors.initials: A
authors.lastname: Ben Slama
authors.forename: Asma
authors.initials: A
authors.lastname: Kahloun
authors.forename: Rafik
authors.initials: R
authors.lastname: Jmaa
authors.forename: Imed
authors.initials: I
authors.lastname: Harrabi
authors.forename: Lamia
authors.initials: L
authors.lastname: Golli
authors.forename: Salem
authors.initials: S
authors.lastname: Ajmi
mesh_terms: D001201:Ascites / Q000401:mortality / Q000821:virology; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000821:virology; D004932:Esophageal and Gastric Varices / Q000401:mortality / Q000821:virology; D005260:Female; D006501:Hepatic Encephalopathy; D006509:Hepatitis B / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality* / Q000821:virology*; D008113:Liver Neoplasms / Q000401:mortality / Q000821:virology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014416:Tunisia