Researchers Call for Reassessment:Cirrhosis Classification System

Researchers Call for Reassessment of Cirrhosis Classification System: Presented at AASLD

By Cheryl Lathrop

BOSTON -- November 3, 2010 -- The prognostic value of previously proposed stages for cirrhosis of the liver should be carefully updated, researchers said here at the 61st Annual Meeting of the American Association for the Study of Liver Diseases (AASLD).

The results of a study show that the survival of patients with stage 4 cirrhosis appears to be largely underestimated.

Savino Bruno, MD, Ospedale Fatebenefratelli, Milan, Italy, and colleagues reported findings from the Italian Association for the Study of the Liver (Associazione Italiana per lo Studio del Fegato [AISF])-EPASCO study during a poster session here on November 1.

Based on a previous systematic review, a staging classification of the prognosis for patients with cirrhosis of the liver has been proposed. In particular, stage 3 (ascites +- oesophageal varices) and stage 4 (portal hypertensive gastrointestinal bleeding +- ascites) were reported being associated with a cumulative 1-year mortality rate of 20% and 57%, respectively.

The AISF-EPASCO is a prospective 3-year follow-up study that assessed both the mortality rate (at 1 and 3 years) and predictors associated with poor outcome of patients with cirrhosis since the first episode of decompensation.

Between March 2006 and October 2007, consecutive cirrhotic patients admitted for the first episode of clinical decompensation (ascites, spontaneous bacterial peritonitis, hepato-renal syndrome, jaundice, gastrointestinal bleeding, porto-systemic encephalopathy) in 29 Italian referral centres were registered in a pre-established, electronic case report form database. Patients with previous or concurrent diagnosis of hepatocellular carcinoma were excluded. All patients were treated according to current international guidelines.

A total of 417 patients were analysed. There were 346 stage 3 patients and 71 stage 4 patients.

The researchers confirmed the rate of 1-year mortality in stage 3 cirrhosis, but survival of patients in stage 4 formerly reported appeared to be largely underestimated. One-year liver-related mortality was 18.0% for stage 3 (previously found to be 20%) and 5.9% (previously found to be 57%) for stage 4. In patients with stage 4 cirrhosis, the presence of ascites did not affect survival.

"The prognostic value of previously proposed stages should be carefully updated," said Dr. Bruno.

[Presentation title: Low Rate of Mortality in Patients With Stage 4 Cirrhosis: The Need of a Reassessment of an Old Classification. The A.I.S.F.-EPASCO Prospective Multicentre Study. Abstract 1160]

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