Prognosis Worse for Liver Cirrhosis Patients with Ascites

Whenever ascites are present and liver function is impaired, the outcomes for liver cirrhosis patients is almost always poor. However, there remains a scarcity for up-to-date data coming from large-scale real-world settings.

A team, led by Hiroshi Yatsuhashi, Hiroshi Yatsuhashi National Hospital Organization Nagasaki Medical Center, investigated the hospital mortality of liver cirrhosis inpatients in Japan.

The Study

In the retrospective cohort study, the investigators examined data on 57,769 liver cirrhosis inpatients between January 2011 and September 2018. The data was extracted from an administrative claims database.

The investigators sought a main outcome of in-hospital mortality and examined the 1- and 3-year cumulative survival rates for liver cirrhosis etiology, Child-Pugh classification, and ascites presence or absence using Kaplan-Meier analysis.

In addition, the research team examined the survival up to 1 year for tolvaptan prescription or non-prescription.

The Results

Ultimately, the investigators found survival rates did not significantly differ among etiologies, with an overall better prognosis for alcohol etiology and poorer prognosis for hepatitis C virus (HCV).

When using the Child-Pugh classification, the researchers found the 1- and 3-year survival rates were 90.2% and 75.3% for grade A, 73.5% and 53.9% for grade B, and 41.9% and 28.9% for grade C, respectively.

After matching patients with ascites using a propensity score, the researchers found the prognosis was poor in general. However, it was better at 6 months (58.1%) or similar at 1 year (47.1%) in patients prescribed tolvaptan compared to patients not prescribed tolvaptan (54.8% and 47.5%, respectively).

“Poorer prognosis was suggested in inpatients with cirrhosis who had a worse Child‐Pugh grade and ascites,” the authors wrote.

A Study on Albumin Levels

Recently, researchers renewed interest in another area of cirrhosis treatment that suffered from a dearth of large-scale trial data.

Whether targeting a serum albumin level of 30 g per liter or greater in this patient population with repeated daily infusions of 20% human albumin solution, compared to standard care, could reduce the incidences of infection, kidney dysfunction, and death is largely unknown.

A team, led by Louise China, PhD, Institute for Liver and Digestive Health, examined whether albumin is beneficial for hospitalized patients with decompensated cirrhosis who had a serum albumin level of less than 30 g per liter at enrollment.

In the randomized, multicenter, open-label, parallel-group trial, the investigators randomly assigned 777 patients to receive either targeted 20% human albumin solution for up to 14 days or until discharge or standard care.

The investigators sought a composite primary endpoint of new infections, kidney dysfunction, or deaths between days 3-15 following treatment initiation.

Overall, the proportion of patients who met the primary endpoint did not significantly differ between the 2 groups.

In the targeted albumin group, 113 patients (29.7%) met the primary endpoint, while 120 individuals (30.2%) in the standard care group met the primary endpoint (aOR, 0.98; 95% CI, 0.71-1.33; P = 0.87).

In a time-to-event analysis where the researchers censored data at the time of discharge or at day 15, they found now significant between-group differences (HR, 1.04; 95% CI, 0.81-1.35).

The study, “The real‐world of hospital mortality for liver cirrhosis inpatients in Japan: a large‐scale cohort study using a medical claims database,” was published online in Hepatology Research.