Mortality risk according to different clinical characteristics of first episode of liver decompensation in cirrhotic patients: a nationwide, prospective, 3-year follow-up study in Italy

Objectives:The occurrence of decompensation marks a crucial turning point i. The course of cirrhosis. The purpose of this study was to asses. The risk of mortality according t. The clinical characteristics of first decompensation, considering als. The impact of acute-on-chronic liver failure (AoCLF).Methods:We conducted a prospective nationwide inception cohort study in Italy. Decompensation was defined b. The presence of ascites, either overt or detected by ultrasonography (UD), gastroesophageal variceal bleeding (GEVB), and hepatic encephalopathy (HE). AoCLF was defined according t. The Asian Pacific Association fo. The Study o. The Liver criteria. Multivariable Cox proportional hazards regression was used to analyz. The risk of failure (death or orthotopic liver transplantation (OLT)).Results:A total of 490 consecutive cirrhotic patients (314 males, mean age 60.9±12.6 years) fulfille. The study criteria. AoCLF was identified in 59 patients (12.0%). Amon. The remaining 431 patients, ascites were found in 330 patients (76.6%): in 257 (77.8%) as overt ascites and in 73 (22.2%) as UD ascites. GEVB was observed in 77 patients (17.9%) and HE in 30 patients (7.0%). After a median follow-up of 33 months, 24 patients underwent OLT and 125 died. The cumulative incidence of failure (death or OLT) after 1, 2, and 3 years was, respectively, 28, 53, and 62% in patients with AoCLF; 10, 18, and 25% in patients with UD ascites; 17, 31, and 41% in patients with overt ascites; and 8, 12, and 24% in patients with GEVB (P<0.0001).Conclusions:AoCLF is responsible for a relevant proportion of first decompensation in cirrhotic patients and is associated wit. The poorest outcome. Patients with UD ascites do not have a negligible mortality rate and require clinical monitoring similar to that of patients with overt ascites.