The Retrospective Study Of Prognostic Related Factors Of Liver Cirrhosis

Objective: To investigate the prognostic risk factors of liver cirrhosis.Methods: This is a retrospective investigation. 90 patients with liver cirrhosis who died in the Second Affiliated Hospital of Dalian Medical University during July1993 and July 2006 were entered as death group, 129 hospitalized patients with liver cirrhosis who survived in the corresponding time period were selected as control group. 34 factors such as sex, age, etiology, course of disease, cause of death, biochemical factors (including serum alanine aminotransferase (ALT), alkaline phosphatase (AKP), albumin, bilirubin, prothrombin time, cholesterol, triglyceride, high-density lipoproteins, sodium, potassium, chlorine, platelet, creatinine et al), abdominal ultrasonography, gastroscope, complications of liver cirrhosis and child-Pugh class were documented. First, all the variables were examined by univariate analysis, and those with statistical significance in univariate analysis were examined with a multivariate analysis using Logistic regression procedures, then verified the major risk factor of prognosis in liver cirrhosis. Second, all the patients with liver cirrhosis (including death and survival) were divided into two groups according to the major risk factor. The two groups were examined with the same univariate analysis and multivariate analysis using Logistic regression procedures to search related factors which influenced the major risk factor. Two regression equations were obtained. We also compared the direct causes of death of liver cirrhosis between the elderly and the younger patients.Results:1. The analysis of the direct causes of death with liver cirrhosis demonstrated that upper gastrointestinal hemorrhage was 35.6%, hepatic encephalopathy was 32.2%, primary hepatic carcinoma was 10%, hepatorenal syndrome was 8.9%,septic shock was 4.4%, acid-base imbalance was 3.3%, the others were 5.6%.2. The major cause of death in the elderly patients (age 60 and older) with liver cirrhosis was hepatic encephalopathy (23/56), upper gastrointestinal hemorrhage (14/56), the others (19/56), which in the younger patients (under age 60) with liver cirrhosis was upper gastrointestinal hemorrhage (18/34), hepatic encephalopathy (6/34), the others (10/34). The cause of death between the elderly and younger patients was examined with chi square test. Chi square test revealed that the difference had statistical significance (χ2=8.382 , P=0.015, p<0.05). Upper gastrointestinal hemorrhage was the most major cause of death in the younger patients, while hepatic encephalopathy was that in the elderly patients.3.Univariate analysis showed that serum albumin, bilirubin, prothrombin time, cholesterol, high-density lipoproteins, sodium, potassium, chlorine, creatinine, portal vein diameter, ascites, esophageal varices, red color sign, upper gastrointestinal hemorrhage , hepatic encephalopathy, electrolyte disturbances, acid-base imbalance, hepatorenal syndrome and Child-Pugh class demonstrated statistical significance (p<0.05~0.000) between death group and survival group. Multivariate Logistic regression analysis revealed that upper gastrointestinal hemorrhage, acid-base imbalance, portal vein diameter, hepatic encephalopathy, electrolyte disturbances, Child-Pugh class, serum potassium positively correlated with death of liver cirrhosis and were independent prognostic risk factors of liver cirrhosis. Upper gastrointestinal hemorrhage and acid-base imbalance were the major risk factors ( the regression coefficients were 2.404 and1.658, relative risk were 11.069 and 5.251, respectively).4.Univariate analysis showed that course of disease, AKP, serum sodium, esophageal varices, red color sign, portal hypertensive gastropathy, Child-Pugh class demonstrated statistical significance (p<0.05) between upper gastrointestinal hemorrhage and non upper gastrointestinal hemorrhage in liver cirrhosis. Multivariate Logistic regression analysis showed that red color sign, esophageal varices, course of disease positively correlated with upper gastrointestinal hemorrhage in liver cirrhosis and were independent risk factors (the regression coefficients were1.621,0.359 and 0.007. relative risk were 2.223,1.007 and 0.968.respectively). Serum sodium and AKP negtively correlated with upper gastrointestinal hemorrhage in liver cirrhosis.Conclusions:1. Red color sign, esophageal varices, course of disease were independent risk factors of upper gastrointestinal hemorrhage in liver cirrhosis, and red color sign was the most major risk factor.2. Upper gastrointestinal hemorrhage, acid-base imbalance, portal vein diameter, hepatic encephalopathy, electrolyte disturbances, Child-Pugh class, serum potassium were independent prognostic risk factors of liver cirrhosis. Upper gastrointestinal hemorrhage and acid-base imbalance were the major risk factors.3. The major causes of death of liver cirrhosis were upper gastrointestinal hemorrhage and hepatic encephalopathy. Upper gastrointestinal hemorrhage was the most major cause of death in the younger patients, while hepatic encephalopathy was that in the elderly patients.