title: 1 and 5 year survival estimates for people with cirrhosis of the liver in England, 1998-2009: a large population study.
abstract: OBJECTIVE
  Large, population-based studies that have included the full spectrum of cirrhosis estimating survival, taking into account time-at-risk are lacking. We aimed to report 1- and 5-year average survival rates for people with cirrhosis to be used in a clinical and healthcare policy setting.
  
  
  METHODS
  We used the Clinical Practice Research Datalink and linked English Hospital Episode Statistics to identify adult cases of cirrhosis from January 1998 to December 2009. We estimated 1- and 5-year survival according to whether time-at-risk was ambulatory or followed an emergency hospital admission related to liver disease, stratified by age, sex, and aetiology to be used in a clinical setting. We used a multivariate Cox-proportional hazards model with a time-varying variable, adjusted for Baveno IV stage of cirrhosis at diagnosis, age, aetiology, and sex.
  
  
  RESULTS
  We identified 5118 incident cases. Average survival probabilities at 1- and 5-years were 0.84 (95% CI 0.83-0.86) and 0.66 (95% CI 0.63-0.68) for the ambulatory group and 0.55 (95% CI 0.53-0.57) and 0.31 (95% CI 0.29-0.33) following hospitalisation, respectively. A hospital admission at diagnosis or subsequently for liver disease substantially impaired prognosis independent of stage of cirrhosis (HR=2.78, 95% CI 2.53, 3.06).
  
  
  CONCLUSIONS
  Emergency hospitalisation for liver disease heralds a downturn in a patient's outlook independent of their stage of cirrhosis. Our results provide population-based clinically translatable estimates of prognosis for the purposes of healthcare delivery and planning and communication to patients.
authors.affiliation: Division of Epidemiology & Public Health, University of Nottingham, UK. Electronic address: sonia.ratib@nottingham.ac.uk.
authors.forename: Sonia
authors.initials: S
authors.lastname: Ratib
authors.affiliation: Division of Epidemiology & Public Health, University of Nottingham, UK.
authors.forename: Kate M
authors.initials: KM
authors.lastname: Fleming
authors.affiliation: Division of Epidemiology & Public Health, University of Nottingham, UK.
authors.forename: Colin J
authors.initials: CJ
authors.lastname: Crooks
authors.affiliation: NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK.
authors.forename: Guruprasad P
authors.initials: GP
authors.lastname: Aithal
authors.affiliation: Division of Epidemiology & Public Health, University of Nottingham, UK.
authors.forename: Joe
authors.initials: J
authors.lastname: West
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016208:Databases, Factual; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000209:etiology / Q000401:mortality*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors
keywords: Aetiology; CPRD; Cirrhosis; Clinical Practise Research Datalink; HES; Hospital Episode Statistics; ICD10; International Classification of Disease 10th version; ONS; OPCS4; Office of National Statistics; Office of Population Censuses and Surveys’ classification of interventions and procedures 4th version; Population-based; Survival; UTS; up to standard