Natural history of hepatitis B virus-related cirrhotic patients hospitalized to control ascites

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Natural history of hepatitis B virus-related cirrhotic patients hospitalized to

control ascites

Authors: Kim, Seung Up1; Han, Kwang-Hyub; Nam, Chung Mo; Park, Jun Yong; Kim, Do

Young; Chon, Chae Yoon; Ahn, Sang Hoon

Source: Journal of Gastroenterology and Hepatology, Volume 23, Number 11,

November 2008 , pp. 1722-1727(6)

Publisher: Blackwell Publishing

Abstract:

Background and Aim: 

Few studies have assessed the natural history of hepatitis B virus (HBV)-related

cirrhotic ascites. We investigated the natural history of patients with

HBV-related cirrhotic ascites hospitalized to control ascites and determined

their prognosis, including survival rates and prognostic factors affecting

survival.

Methods: 

Between January 1996 and December 2005, 203 consecutive patients with

HBV-related cirrhotic ascites were followed for a median of 80.7 months (range,

15-149) after their first significant ascitic decompensation that required

hospitalization.

Results: 

The mean age of all patients was 52.6 years. Male gender predominated

(male/female, 138/65). A subgroup analysis of 165 patients who had ascitic

decompensation as their first episode of hepatic decompensation revealed that

gastrointestinal variceal bleeding developed after a median interval of 8 months

following ascitic decompensation in 31 (18.8%) patients, hepatic encephalopathy

occurred at 9 months in 53 (32.1%), spontaneous bacterial peritonitis appeared

at 12.7 months in 24 (14.5%), hepatorenal syndrome occurred at 8.1 months in

five (3%), and hepatocellular carcinoma was observed at 21.2 months in 10

(6.1%). The overall median survival was 12.4 months. The 1- and 3-year survival

rates were 50.7 and 18.7%. The prognostic factors that independently correlated

with survival at the time of ascitic decompensation were Child-Pugh

classification B/C (P = 0.030), serum white blood cell (WBC; P = 0.035),

serum creatinine (Cr; P = 0.039), serum sodium (Na; P = 0.010), and

antiviral therapy (P = 0.040).

Conclusions: 

The prognosis of HBV-related cirrhotic patients with ascitic decompensation is

poor. Child-Pugh class, serum WBC/Cr/Na, and antiviral therapy primarily

influenced survival.