%0 Journal Article
%T The clinical course of alcoholic cirrhosis: effects of hepatic metabolic capacity, alcohol consumption, and hyponatremia ¨C a historical cohort study
%A Peter Jepsen
%A Peter Ott
%A Per Andersen
%A Hendrik Vilstrup
%J BMC Research Notes
%D 2012
%I BioMed Central
%R 10.1186/1756-0500-5-509
%X We followed a Danish community-based cohort of 466 patients with alcoholic cirrhosis. Stratified Cox regression was used to examine the effects of GEC (a measure of hepatic metabolic capacity), alcohol consumption, and plasma sodium concentration (a measure of circulatory dysfunction) on the hazard rates of first-time hepatic encephalopathy, first-time ascites, first-time variceal bleeding, and mortality. We adjusted for confounding by comorbidity, gender, and age. Data on risk factors and confounders were updated during follow-up.A low GEC increased the risk of first-time hepatic encephalopathy (hazard ratio [HR] 1.21 per 0.1 mmol/min GEC loss, 95% CI 1.11-1.31), but was unassociated with other adverse events. Alcohol consumption increased the risk of first-time ascites (HR 3.18, 95% CI 1.19-8.47), first-time variceal bleeding (HR 2.78, 95% CI 1.59-4.87), and mortality (HR 2.45, 95% CI 1.63-3.66), but not the risk of first-time hepatic encephalopathy. Hyponatremia increased the risk of all adverse events.Reduced hepatic metabolic capacity, alcohol consumption, and hyponatremia were causally involved in the development of specific complications to alcoholic cirrhosis.We recently described the development of hepatic encephalopathy, ascites, and variceal bleeding in Danish patients with alcoholic cirrhosis [1]. The appearance of these complications increased mortality, but they developed in random sequence. Therefore mortality predictions based solely on their presence or absence are inherently inaccurate, and other determinants of the clinical course should be identified.Cirrhosis patients have reduced hepatic metabolic capacity, and the residual capacity can be measured with the galactose elimination capacity (GEC) test [2], the result of which is a strong predictor of mortality [3]. Some patients with alcoholic cirrhosis continue drinking alcohol, and such exposure to the etiology of their disease increases mortality [4]. Finally, cirrhosis is accompanied by renal
%K Alcoholic liver disease
%K Hepatic encephalopathy
%K Ascites
%K Variceal bleeding
%K Prognosis
%U http://www.biomedcentral.com/1756-0500/5/509