Original articles
Long-term survival and cause-specific mortality in patients with cirrhosis of the liver: a nationwide cohort study in Denmark

https://doi.org/10.1016/S0895-4356(02)00531-0Get rights and content

Abstract

Mortality from cirrhosis of the liver has been examined in few long-term follow-up studies. In the Danish National Registry of Patients, 1982–1989, we identified a cohort of 10,154 patients with liver cirrhosis and divided them according to the etiology of their liver disease. Causes of death were identified in the Danish Death Registry, 1982–1993. We estimated relative survival and standardized mortality ratios by comparing with the mortality in the general population. The 10-year relative survival was worse in patients with alcoholic cirrhosis (34%) or nonspecified cirrhosis (32%) than in patients with primary biliary cirrhosis (58%) or chronic hepatitis (66%). The standardized mortality ratio for all causes of death combined was 12-fold increased, 5-fold excluding cirrhosis-related causes. Mortality in all disease categories was increased, even in those not traditionally related to cirrhosis. In conclusion, patients with cirrhosis of the liver face reduced life expectancy due to several causes of death.

Introduction

Liver cirrhosis and its complications are major clinical problems that carry a considerable risk of disability and death. There is no curative treatment for liver cirrhosis, so prevention and treatment of complications such as variceal hemorrhage, ascites, and encephalopathy are keystones for the clinical care of these patients. Because the liver plays an important role for many vital functions (eg, immunity, metabolism, and coagulation), the range of cirrhotic complications is broad. Consequently, understanding the disease process, making appropriate risk stratification, and implementing tertiary prevention requires valid and precise understanding of outcomes such as mortality patterns. The short-term prognosis of liver cirrhosis is relatively well described within the framework of randomized controlled trials, but population-based reports of long-term follow-up in causes of death are few and limited in size 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13.

To clarify the clinical course of patients with liver cirrhosis, we determined the survival and causes of death of a large cohort of such patients, using population-based data from the Danish National Registry of Patients (NRP) and the Danish Death Registry.

Section snippets

Materials and methods

The study cohort was identified in the NRP, which contains information on all hospital admissions in Denmark (population 5.2 million) since 1977 [14]. Each admission record includes a date of admission, a date of discharge, up to 20 discharge diagnoses, and a civil registry number assigned to all Danes at birth, incorporating date of birth and sex. Diagnoses were classified according to the Danish version of the International Classification of Diseases, 8th edition (ICD-8) during the study

Results

We identified 10,154 patients with liver cirrhosis during the study period; 6374 (63%) were men, and 3780 (37%) were women. The mean age at entry into the study cohort was 56.9 years. The median and mean follow-up were 2.8 years and 3.7 years, respectively; the total number of person-years at risk was 37.382 years. Alcoholic cirrhosis was the largest of the four sub-cohorts (61% of all patients), whereas primary biliary cirrhosis accounted for only 2%. The sub-cohorts of primary biliary

Discussion

This analysis of more than 10,000 patients with liver cirrhosis and complete nationwide long-term follow-up showed that patients with liver cirrhosis have a high mortality, even for causes of death not usually associated with chronic liver disease. Survival was particularly poor within the first year after the initial hospitalization for cirrhosis and in patients with alcoholic and nonspecified cirrhosis.

Our study has important strengths and limitations. We used nationwide, population-based

Acknowledgements

This study received financial support from the Western Danish Research Forum for Health Sciences (Vestdansk Forskningsforum).

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