OBJECTIVES

There are large variations of cirrhosis-related mortality worldwide. This study examined proportions of various causes of death among decompensated cirrhosis (DC) patients and how risks differ by etiology (viral hepatitis B (HBV) or C (HCV)), in order to illustrate the health burden generated by ill-managed cirrhosis.

METHODS

In our retrospective cohort study, a population-based insurance claims database was used to identify non-alcoholic DC patients (ICD-9-CM 571.5, 571.6) between 20 and 80 years of age in Taiwan during 1999-2010. Patients with an alcoholic history were excluded. Endpoint was in-hospital death or death within two weeks following discharge. Disease-specific complications recorded in their last hospitalization before death (jaundice, ascites, variceal hemorrhage, encephalopathy, hepatocellular carcinoma (HCC)) were considered in determining major causes of death. Cox's proportional hazard models were performed to estimate the relationship between etiology and mortality, adjusting for patient demographics and clinical profile.

RESULTS

We identified a total of 141,757 hospitalized DC patients: 69% were male and mean age was 59.0±12.8 years. Median follow-up duration was 2.27 years. At baseline, about 22% and 19% were HBV and HCV patients, respectively. All-cause mortality was observed in 43% (n=60,904) of subjects. After stratify by complication, highest mortality was attributable to variceal hemorrhage (23.7%), followed by ascites (21.0%), and encephalopathy (18.8%). Death by HCC was seen in 9.1% (n=12,970) of DC subjects. In multivariate analyses, HBV and HCV etiology was associated with increased all-cause mortality (hazard ratio (HR): 1.25, 95% confidence interval (CI): 1.23-1.28; HR: 1.04, 95% CI: 1.02-1.06), respectively), and higher HCC-specific mortality (HR: 2.79, 95% CI: 2.67-2.90; HR: 2.16, 95% CI: 2.06-2.25, respectively).

CONCLUSIONS

This study demonstrated that DC patients have a very high risk of mortality. A significant portion of them die from complications, and HBV/HCV can exacerbate risk once DC is progressed to HCC. Timely management of complications in DC patients is critical.