title: Survival of patients with alcoholic and cryptogenic cirrhosis without liver transplantation: a single center retrospective study.
abstract: BACKGROUND
  There is no recent data addressing the long term survival of cirrhosis patients without transplantation, but with the availability of optimal pharmacological and endoscopic therapies. We compared the long term transplant free survival of alcoholic (AC) and cryptogenic (CC) cirrhosis patients in a setting where liver transplantation was, until very recently, not available. AC and CC patient details were extracted from our database, maintained since 1995. For those who had not attended clinics within the past 4 weeks, the patient or families were contacted to obtain survival status. If deceased, cause of death was ascertained from death certificates and patient records. Survival was compared using Kaplan-Meier curves.
  
  
  RESULTS
  Complete details were available in 549/651 (84.3%) patients (AC 306, CC 243). Mean follow up duration (SD) (months) was 29.9 (32.6). 82/96 deaths (85.4%) among AC and 80/94 deaths (85.1%) among CC were liver related. Multivariate analysis showed age at diagnosis and Child's class predicted overall survival among all groups. The median survival in Child's class B and C were 53.5 and 25.3 months respectively. Survival was similar among AC and CC. Among AC survival was improved by abstinence [HR = 0.63 (95% CI: 0.40-1.00)] and was worse with diabetes [HR=1.59 (95% CI: 1.02- 2.48)] irrespective of alcohol status.
  
  
  CONCLUSIONS
  The overall survival of AC was similar to CC. Death in both groups were predominantly liver related, and was predicated by age at diagnosis and Child class. Among AC, presence of diabetes and non-abstinence from alcohol were independent predictors for poor survival.
authors.affiliation: University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka.
authors.forename: Sudul Mananjala
authors.initials: SM
authors.lastname: Senanayake
authors.forename: Madunil Anuk
authors.initials: MA
authors.lastname: Niriella
authors.forename: Sanjaya Kumara
authors.initials: SK
authors.lastname: Weerasinghe
authors.forename: Anuradhani
authors.initials: A
authors.lastname: Kasturiratne
authors.forename: Jerome Praneeth
authors.initials: JP
authors.lastname: de Alwis
authors.forename: Arjuna Priyadarsin
authors.initials: AP
authors.lastname: de Silva
authors.forename: Anuradha Supun
authors.initials: AS
authors.lastname: Dassanayake
authors.forename: Hithanadura Janaka
authors.initials: HJ
authors.lastname: de Silva
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000428:Alcohol Drinking / Q000401:mortality; D002423:Cause of Death; D003644:Death Certificates; D003920:Diabetes Mellitus / Q000401:mortality; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D008104:Liver Cirrhosis, Alcoholic / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013188:Sri Lanka / Q000453:epidemiology; D013695:Temperance; D013997:Time Factors