title: Different patterns of decompensation in patients with alcoholic vs. non-alcoholic liver cirrhosis.
abstract: BACKGROUND
  The histological pattern of fibrosis in liver cirrhosis varies in different chronic liver diseases, and hepatic decompensation may be differentiated in consequences of fibrosis (i.e. ascites, variceal bleeding) or in lack of function (i.e. jaundice) resulting in aetiology-specific variable morbidity and mortality.
  
  
  OBJECTIVE
  To evaluate patterns of hepatic decompensation in relation to the aetiology of liver cirrhosis.
  
  
  METHODS
  Two different cohorts were retrospectively evaluated between 2002 and 2007. Cohort A was for hypothesis generation and consisted of 220 cirrhotic patients. To confirm the initial observations a second cohort B (n = 217) was analysed. The different patterns of hepatic decompensation evaluated were ascites, jaundice, encephalopathy, variceal bleeding, spontaneous bacterial peritonitis, hepatorenal syndrome or hepatocellular carcinoma. Furthermore, we analysed survival in relation to pattern of decompensation in alcoholic vs. non-alcoholic liver disease.
  
  
  RESULTS
  Alcoholics were more frequently hospitalised for ascites (cohort A: 81.4% vs. 65.4%, P = 0.016; cohort B 71.3% vs. 58.5%, P = 0.085). In contrast, non-alcoholics presented with higher rates of hepatocellular carcinoma (cohort A: 23.1% vs. 11.9%, P = 0.046; cohort B 38.6% vs. 22.5%, P = 0.018). There were no significant differences in jaundice, variceal bleeding, hepatorenal syndrome or encephalopathy. Survival was significantly impaired in non-alcoholic cirrhosis once ascites occurred (P = 0.003), whereas ascites did not predict higher mortality in patients with alcoholic cirrhosis.
  
  
  CONCLUSIONS
  Ascites is the leading initial pattern of decompensation in alcoholic cirrhosis whereas hepatocellular carcinoma dominates in non-alcoholics. Non-alcoholics developing ascites show a poor survival.
authors.affiliation: Universitätsklinikum Leipzig, Klinik und Poliklinik für Gastroenterologie und Rheumatologie, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Wiegand
authors.forename: M
authors.initials: M
authors.lastname: Kühne
authors.forename: P
authors.initials: P
authors.lastname: Pradat
authors.forename: J
authors.initials: J
authors.lastname: Mössner
authors.forename: C
authors.initials: C
authors.lastname: Trepo
authors.forename: H L
authors.initials: HL
authors.lastname: Tillmann
mesh_terms: D000367:Age Factors; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects; D001201:Ascites / Q000209:etiology*; D006528:Carcinoma, Hepatocellular / Q000209:etiology; D015331:Cohort Studies; D004932:Esophageal and Gastric Varices / Q000209:etiology; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000401:mortality; D008104:Liver Cirrhosis, Alcoholic / Q000175:diagnosis* / Q000401:mortality; D008113:Liver Neoplasms / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies