| Abstract |
This thesis aimed: (1) to study the characteristics and prognostic patterns in a Greek cirrhotic patient population, (2) to prospectively screen cirrhotics with arterial blood gases and albumin perfusion scan, identify those fulfilling the classic hepatopulmonary syndrome (HPS) criteria, correlate with clinical parameters and evaluate the survival of patients with HPS compared to those without HPS, (3) to compare the prognostic accuracy of ALBI, MELD, MELDNa, Child-Pugh and the corrected for Creatinine Child-Pugh score in a genetically homogeneous Cretan cirrhotic population.
Commonest aetiology was hepatitis C virus (HCV, 41%) followed by alcohol (31%). The median survival time in compensated cirrhotics was 115 months (95%CI: 95-133), whereas in decompensated patients was 55 months (95%CI: 36-75). HCV patients survived longer while HBV patients had over twice the risk of death of HCV patients. The median time to decompensation was 65 months (95%CI: 51-79), with alcoholics having the highest risk (RR = 2.1 vs HCV patients). Hepatitis B virus patients had the highest risk of hepatocellular carcinoma and alcoholics the lowest. Leading causes of death: liver failure, hepatorenal syndrome, sepsis and HCC progression.
There was no difference in HPS between decompensated (24.6%) and compensated cirrhosis (27.3%). In the multivariate analysis only the quantitative index was significant for the diagnosis of HPS (p= 0.001, OR; 95% CI: 7.05; 2.27-21.87). Kaplan- Mayer survival curves indicated a similar overall prognosis for patients diagnosed with HPS (p-value= 0.105).
ALBI had an optimum balance between sensitivity and specificity (AUC =0.704, 95% CI= 0.630-0.778) compared to the others scores. In the multivariate analysis, the only factors independently associated with death were the ALBI score (HR= 2.51; 95% CI: 1.69-3.73, p<0.001), the MELDNa score (HR=1.04; 95% CI: 1.00-1.09, p=0.045) and age (HR= 1.05; 95% CI: 1.03-1.07, p<0.001). When only decompensated cirrhosis was evaluated, the multivariate analysis showed that the ALBI score (HR= 3.03; 95% CI: 1.92-4.78, p<0.001) and age (HR= 1.05; 95% CI: 1.03-1.07, p<0.001) were independently associated with death. The results of this study indicate that cirrhosis aetiology and decompensation at presentation are predictors of survival. Alcoholics have the highest decompensation risk, HBV cirrhotics the highest risk of HCC and HCV cirrhotics the highest decompensation-free time. HPS is a frequent complication of cirrhosis. Mild to moderate HPS has no significant effect on survival of cirrhotic patients. The quantitative Tc-MAA test is a reliable tool for diagnosis. ALBI score might be a better prognostic indicator of mortality in cirrhosis and due to its simplicity may substitute for the Child-Pugh scores, MELD and MELD Na score.
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Μελέτη της συχνότητας, της φυσικής πορείας και θεραπευτικής ανταπόκρισης των επιπλοκών της κιρρώσεως
