title: Serum Albumin Can Identify Patients With Compensated Cirrhosis With a Good Prognosis.
abstract: BACKGROUND
  Many prognostic studies in cirrhosis were performed without distinguishing between compensated and decompensated patients and/or have evaluated the prognostic role of variables that are not routinely used. The aim was to evaluate predictors of survival in compensated and decompensated cirrhosis separately but in a concurrent cohort and focused on routine clinical variables.
  
  
  METHODS
  Secondary analysis of a prospective cohort with cirrhosis collected in a tertiary center between August 2000 and May 2002 and followed until death or April 2006. Univariate, stratified univariate analysis, and multivariate Cox regression analysis were performed. Receiving operating characteristics curves were used to identify the best cutoff of variables predictive of death.
  
  
  RESULTS
  A total of 242 patients were included (122 compensated, 120 decompensated). In a median follow-up of 30 months (range, 6 to 50 mo), 62 (26%) deaths occurred, 24 (20%) in the compensated and 38 (32%) in the decompensated group. In the whole cohort, decompensation was the strongest predictor of death. In the compensated group, age, albumin, and platelets and in the decompensated group model for end-stage liver disease, platelets, and albumin were identified as independent predictors of death. A serum albumin of 4 g/dL was the best cutoff to identify patients at risk for death in the compensated group with a hazard ratio of 13.3 [95% confidence interval, 1.8-98.8] in those with an albumin of <4.0 g/dL.
  
  
  CONCLUSIONS
  Albumin is a predictor of death in compensated and decompensated cirrhosis. In compensated cirrhosis a subset patients with particularly good prognosis can be identified. Different predictors were observed in both stages, confirming that compensated and decompensated cirrhosis are 2 separate disease stages.
authors.affiliation: *Section of Digestive Diseases, Yale University School of Medicine and VA-CT Healthcare System, New Haven, CT †Department of Internal Medicine I, Martin-Luther-University, Halle-Wittenberg Halle, Germany.
authors.forename: Cristina
authors.initials: C
authors.lastname: Ripoll
authors.forename: Khurram
authors.initials: K
authors.lastname: Bari
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Garcia-Tsao
mesh_terms: D000367:Age Factors; D001201:Ascites / Q000150:complications; D015415:Biomarkers / Q000097:blood; D004932:Esophageal and Gastric Varices / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000209:etiology / Q000401:mortality*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010976:Platelet Count / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D012044:Regression Analysis; D012709:Serum Albumin / Q000032:analysis*; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D012709:Serum Albumin