1 and 5 year survival estimates for people with cirrhosis of the liver in England, 1998–2009: a large population study

Ratib, Sonia; Fleming, Kate M.; Crooks, Colin J.; Aithal, Guru P.; West, Joe

Abstract

BACKGROUND & AIMS:
Large, population-based studies that have included the full spectrum of cirrhosis estimating survival, taking into account time-at-risk are lacking. We aimed to report 1- and 5-year average survival rates for people with cirrhosis to be used in a clinical and healthcare policy setting.

METHODS:
We used the Clinical Practice Research Datalink and linked English Hospital Episode Statistics to identify adult cases of cirrhosis from January 1998 to December 2009. We estimated 1- and 5-year survival according to whether time-at-risk was ambulatory or followed an emergency hospital admission related to liver disease, stratified by age, sex, and aetiology to be used in a clinical setting. We used a multivariate Cox-proportional hazards model with a time-varying variable, adjusted for Baveno IV stage of cirrhosis at diagnosis, age, aetiology, and sex.

RESULTS:
We identified 5118 incident cases. Average survival probabilities at 1- and 5-years were 0.84 (95% CI 0.83-0.86) and 0.66 (95% CI 0.63-0.68) for the ambulatory group and 0.55 (95% CI 0.53-0.57) and 0.31 (95% CI 0.29-0.33) following hospitalisation, respectively. A hospital admission at diagnosis or subsequently for liver disease substantially impaired prognosis independent of stage of cirrhosis (HR=2.78, 95% CI 2.53, 3.06).

CONCLUSIONS:
Emergency hospitalisation for liver disease heralds a downturn in a patient's outlook independent of their stage of cirrhosis. Our results provide population-based clinically translatable estimates of prognosis for the purposes of healthcare delivery and planning and communication to patients.

Citation

Ratib, S., Fleming, K. M., Crooks, C. J., Aithal, G. P., & West, J. (2014). 1 and 5 year survival estimates for people with cirrhosis of the liver in England, 1998–2009: a large population study. Journal of Hepatology, 60(2), https://doi.org/10.1016/j.jhep.2013.09.027

• Journal Article Type: Article
• Publication Date: Feb 1, 2014
• Deposit Date: Apr 1, 2016
• Publicly Available Date: Apr 1, 2016
• Journal: Journal of Hepatology
• Print ISSN: 0168-8278
• Electronic ISSN: 1600-0641
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 60
• Issue: 2
• DOI: https://doi.org/10.1016/j.jhep.2013.09.027
• Keywords: cirrhosis, survival, aetiology, population-based
• Public URL: https://nottingham-repository.worktribe.com/output/720751
• Publisher URL: http://www.sciencedirect.com/science/article/pii/S0168827813006910