1. Evaluating clinical outcomes and prognosis in patients with cirrhosis and portal hypertension: a retrospective observational cohort study.
- Author
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Lee NHC, Kiddle SJ, Chandankhede S, Agrawal S, Bean DM, Hunt PR, Parker VER, Greasley PJ, and Ambery P
- Subjects
- Humans, Retrospective Studies, Gastrointestinal Hemorrhage epidemiology, Gastrointestinal Hemorrhage etiology, Liver Cirrhosis complications, Liver Cirrhosis epidemiology, Prognosis, Hepatic Encephalopathy complications, Hepatic Encephalopathy epidemiology, Esophageal and Gastric Varices complications, Esophageal and Gastric Varices epidemiology, Hypertension, Portal complications, Hypertension, Portal epidemiology
- Abstract
Objective: Cirrhosis describes the end-stage of chronic liver disease. Irreversible changes in the liver cause portal hypertension, which can progress to serious complications and death. Only a few studies with small sample sizes have investigated the prognosis of cirrhosis with portal hypertension. We used electronic healthcare records to examine liver-related outcomes in patients with diagnosed/suspected portal hypertension., Design: This retrospective observational cohort study used secondary health data between 1 January 2017 and 3 December 2020 from the TriNetX Network, a federated electronic healthcare records platform. Three patient groups with cirrhosis and diagnosed/suspected portal hypertension were identified ('most severe', 'moderate severity' and 'least severe'). Outcomes studied individually and as a composite were variceal haemorrhage, hepatic encephalopathy, complications of ascites and recorded mortality up to 24 months., Results: There were 13 444, 23 299, and 23 836 patients in the most severe, moderate severity and least severe groups, respectively. Mean age was similar across groups; most participants were white. The most common individual outcomes at 24 months were variceal haemorrhage in the most severe group, recorded mortality and hepatic encephalopathy in the moderate severity group, and recorded mortality in the least severe group. Recorded mortality rate was similar across groups. For the composite outcome, cumulative incidence was 59% in the most severe group at 6 months. Alcohol-associated liver disease and metabolic-associated steatohepatitis were significantly associated with the composite outcome across groups., Conclusion: Our analysis of a large dataset from electronic healthcare records illustrates the poor prognosis of patients with diagnosed/suspected portal hypertension., Competing Interests: Competing interests: NHCL was employed by AstraZeneca during the majority of her contributions. SJK is an employee of and owns shares in AstraZeneca. SC is an employee of ZS and worked as a contractor for AstraZeneca. SA is an employee of ZS and worked as a contractor for AstraZeneca. DMB is an employee of and owns shares in AstraZeneca. PRH was employed by AstraZeneca during the majority of his contributions and owned shares in AstraZeneca at the time the work was conducted. VERP is an employee of and owns shares in AstraZeneca. PJG is an employee of and owns shares in AstraZeneca. PA is an employee of and owns shares in AstraZeneca., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2023
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