PROBABILITY OF DEVELOPING GALLSTONES AND RELATED RISK-FACTORS IN 400 CIRRHOTICS

Objective: To estimate the cumulative probability of developing gallst ones and to evaluate possible risk factors in a large series of Italia n cirrhotic patients, free of gallstones at enrolment. Setting: Gastro enterology unit at a Milan teaching hospital and four general hospital s in northern Italy. Patients: The study included 400 consecutive cirr hotic patients (257 men and 143 women, mean age 58 +/- 10 SD and 61 +/ - 10 SD years, respectively). Cirrhosis was due to alcohol abuse (n = 169), chronic infection with hepatitis B virus (n = 31) or non-A, non- B hepatitis virus (NANBV; n = 107, including 75 positive for anti-hepa titis C virus), concomitant chronic hepatitis 8 virus or NANBV infecti on and alcohol abuse (n = 50), and miscellaneous causes (n = 43). At e nrolment, 231 patients were classified as having Child's class A cirrh osis, 130 as B and 39 as C. Statistical analysis: The cumulative proba bility of developing gallstones was estimated by the Kaplan-Meier meth od and possible risk factors evaluated by logistic regression analysis . Results: During a median follow-up of 48 months (range 12 to 132 mon ths), ultrasonography demonstrated the development of gallstones in 94 patients (23.5%, 53 men and 41 women), who were all informed of the f inding. The proportion of symptomatic patients was 10% at diagnosis, w hereas 16.2% manifested gallstone-related symptoms during follow-up. C holecystectomy was carried out in three patients. The cumulative proba bility of gallstone development was 15 and 38% at 4 and 8 years, respe ctively. On logistic regression analysis, high body mass index, female gender and severity of liver disease were significantly associated wi th a higher risk of cholelithiasis. Conclusion: This longitudinal stud y provides further evidence of the clinical importance of gallstones i n cirrhosis, already demonstrated in prevalence studies.