SURVIVAL IN ALCOHOLIC LIVER-CIRRHOSIS - PROGNOSTIC VALUE OF PORTAL PRESSURE, SIZE OF ESOPHAGEAL-VARICES AND BIOCHEMICAL DATA - COMPARISON WITH CHILD CLASSIFICATION

A survival analysis was carried out based on the data of 190 male pati ents with alcoholic liver cirrhosis (Child A: 82.2%; Child B: 17.8%). Patients (mean age: 49.6 +/- 7.1 years) were examined during the perio d 1983-1990. Censoring in May 1993 was based on the recordings of the >>Rentenversicherungsanstalten<<. There were no >>drop-outs<<. During follow-up (mean: 4.2 years) 64 (33.7%) of the patients died. 13 potent ial prognostic variables were examined individually by drawing Kaplan- Meier curves and performing log-rank tests. Portal pressure, determine d during hepatic vein catheterization as hepatic vein pressure gradien t HVPG (P), size of esophageal varices, serum bilirubin, serum albumin , prothrombin time (Quick), thromboplastin time (PTT), cholinesterase (ChE) and Child scores were correlated to survival (p < 0.05), whereas age, gamma GT, IgA, drinking habits and additional diagnoses were not . A multivariate Cox regression analysis stepwise eliminated all but t hree variables: ChE, albumin and variceal size were included in the pr ognostic index PI of the final model. The usefulness of the model was tested by a cross validation method. No significant difference was fou nd between estimated and observed survivorship functions. To compare t he PI of the Cox model with Child's scores, ROC curves of sensitivity and specifity of predicting death within one, three and five years wer e constructed. Better prognostic efficiency was indicated for PI. Beca use ChE, albumin and the size of varices are determined as a routine i n our clinic, we consider the construction of PI an advisable alternat ive to Child's classification.