Chronic Hepatitis Results In Cirrhosis

The natural history of liver cirrhosis in individuals with viral hepatitis was examined by two recent studies. In the May, issue of Gut, L. Benvegnu and colleagues investigated the progression and outcome of initially compensated cirrhosis in a group of 312 Italian patients with hepatitis B (43 patients), C (254 patients), or both (15 patients), followed for an average of about eight years. Every six months, tests were performed to make a judgement about liver disease progression and identify major complications. During the follow-up period, 102 patients (about 33%) developed at least one complication. The most common were hepatocellular carcinoma (HCC, a type of liver cancer; about 21%), ascites (about 20%), gastrointestinal bleeding (about 5%), and encephalopathy (about 2%). About 20% experienced liver disease progression as evidenced by an increased Child-Pugh cirrhosis score. During follow-up, about 19% died from liver disease, most (70%) due to HCC. The authors concluded that HCC was the most frequent and life-threatening complication, particularly in HCV positive cases.

Complication	Percentage
hepatocellular carcinoma	21%
ascites	20%
gastrointestinal bleeding	5%
encephalopathy	2%

The same month in the Journal of Hepatology, Ramon Planas and colleagues from Spain reported on the natural history of decompensated cirrhosis in patients with hepatitis C. Two hundred patients were followed from their first hospitalization for hepatic decompensation; average follow-up was about three years. The most common initial complications related to decompensation were ascites (48%), gastrointestinal bleeding (about 33%), severe bacterial infection (about 15%), and encephalopathy (5%). During follow-up, about 17% developed HCC and about 43% died.

Complication	Percentage
ascites	48%
gastrointestinal bleeding	33%
bacterial infection	15%
encephalopathy	5%

Percentage death caused by chronic liver disease and cirrhosis in the US in year 1999

Percentage	Age
1.0%	25-34 years
3.7%	35-44 years
4.2%	45-54 years
2.4%	55-64 years
1.2%	65-74 years