Risk of further decompensation/mortality in patients with cirrhosis and ascites as the first single decompensation event.

Background & Aims

Although ascites is the most frequent first decompensating event in cirrhosis, the clinical course after ascites as the

Methods

A total of 622 patients with cirrhosis presenting with grade 2/3 ascites as the

Results

The mean age was 57 ± 11 years, and most patients were male (n = 423, 68%) with alcohol-related (n = 366, 59%) and viral (n = 200,32%) liver disease as the main aetiologies. In total, 323 (52%) patients presented with grade 2 and 299 (48%) with grade 3 ascites. The median Child-Pugh score at presentation was 8 (IQR 7-9), and the mean model for end-stage liver disease (MELD) was 15 ± 6. During a median follow-up period of 49 months, 350 (56%) patients experienced further decompensation: refractory ascites (n = 130, 21%), hepatic encephalopathy (n = 112, 18%), spontaneous bacterial peritonitis (n = 32, 5%), hepatorenal syndrome-acute kidney injury (n = 29, 5%). Variceal bleeding as an isolated further decompensation event was rare (n = 18, 3%), whereas non-bleeding further decompensation (n = 161, 26%) and ≥2 concomitant further decompensation events (n = 171, 27%) were frequent. Transjugular intrahepatic portosystemic shunt was used in only 81 (13%) patients. In patients presenting with grade 2 ascites, MELD ≥15 indicated a considerable risk for further decompensation (subdistribution hazard ratio [SHR] 2.18;

Conclusions

Further decompensation is frequent in patients with ascites as a

Lay summary

Decompensation (the development of symptoms as a result of worsening liver function) marks a turning point in the disease course for patients with cirrhosis. Ascites (

Informations de copyright

© 2022 The Author(s).

Déclaration de conflit d'intérêts

The authors have nothing to disclose regarding the work under consideration for publication. The following authors disclose conflicts of interests outside the submitted work: LB, MTo, GS, VC, LH, SI, MJ, BSH, CGC, AA, AB, and SP have nothing to disclose. DB received travel support from AbbVie and Gilead and speaker fees from AbbVie and Siemens, as well as grant support form Gilead and Siemens. MTr received grant support from Albireo, Alnylam, Cymabay, Falk, Gilead, Intercept, MSD, Takeda, and UltraGenyx; honouraria for consulting from Albireo, Boehringer Ingelheim, BiomX, Falk, Genfit, Gilead, Intercept, Janssen, MSD, Novartis, Phenex, Pliant, Regulus, and Shire; speaker fees from Bristol-Myers Squibb, Falk, Gilead, Intercept, and MSD; and travel support from AbbVie, Falk, Gilead, and Intercept. MM served as a speaker and/or consultant and/or advisory board member for AbbVie, Collective Acumen, Gilead, and W.L. Gore & Associates and received travel support from AbbVie and Gilead. TR received grant support from AbbVie, Boehringer-Ingelheim, Gilead, Intercept, MSD, Myr Pharmaceuticals, Philips Healthcare, Pliant, Siemens, and W.L. Gore & Associates; speaking honoraria from AbbVie, Gilead, Gore, Intercept, Roche, and MSD; consulting/advisory board fees from AbbVie, Bayer, Boehringer-Ingelheim, Gilead, Intercept, MSD, and Siemens; and travel support from AbbVie, Boehringer-Ingelheim, Gilead, and Roche. Please refer to the accompanying ICMJE disclosure forms for further details.