LONG COURSE AND PROGNOSTIC FACTORS OF VIRUS-INDUCED CIRRHOSIS OF THE LIVER

Objectives: Chronic infection by hepatitis B virus (HBV) and hepatitis C virus (HCV) is now recognized as a major cause of liver cirrhosis. This study was aimed at evaluating the natural history of the disease in a large series of Italian patients with HBV- and HCV-related cirrho sis without portal hypertension at entry. Methods: The clinical record s of 405 patients (233 males, mean age 54 +/- 9 yr) with histologicall y proven cirrhosis (321 with HCV-related and 84 with HBV-related cirrh osis) and no clinical evidence of portal hypertension at entry were re trospectively examined to evaluate the occurrence of complications and the cumulative mortality rate during follow-up. Results: Patients had a mean follow-up of 8 +/- 3 yr. The cumulative survival rate was 99.1 % at 5 yr, 76.8% at 10 yr, and 49.4% at 15 yr. The age-adjusted death rate was 3.14 and 2.84 times higher than in the general Italian popula tion in men and women, respectively. Only the bilirubin level was an i ndependent indicator of survival. Esophageal varices, ascites, jaundic e, hemorrhage, hepatic encephalopathy, and hepatocellular carcinoma si gnificantly reduced the survival rate (major complications), whereas t hrombocytopenia, diabetes, and cholelithiasis did not affect survival (minor complications). The incidence of hepatocellular carcinoma was s imilar in patients with either HBV- or HCV-related disease and was qui te frequent, especially in males. Conclusions: This study demonstrates that the course of virus-induced liver cirrhosis is not influenced by the etiology of the disease and that the occurrence of complications significantly shortens life expectancy. The longer survival rate obser ved in this study is probably due to the fact that cirrhosis was here recognized by liver biopsy in the absence of clinical evidence of port al hypertension.