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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

Authors

Sonia Ratib sonia.ratib@nottingham.ac.uk

Kate M. Fleming

Colin J. Crooks colin.crooks@nottingham.ac.uk

Guru P. Aithal

Joe West joe.west@nottingham.ac.uk



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.

Journal Article Type Article
Publication Date Feb 1, 2014
Journal Journal of Hepatology
Print ISSN 0168-8278
Electronic ISSN 1600-0641
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 60
Issue 2
APA6 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), doi:10.1016/j.jhep.2013.09.027
DOI https://doi.org/10.1016/j.jhep.2013.09.027
Keywords cirrhosis, survival, aetiology, population-based
Publisher URL http://www.sciencedirect.com/science/article/pii/S0168827813006910
Copyright Statement Copyright information regarding this work can be found at the following address: http://eprints.nottingh.../end_user_agreement.pdf

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Ratib_Manuscript_JHepatology.pdf (675 Kb)
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Copyright Statement
Copyright information regarding this work can be found at the following address: http://eprints.nottingham.ac.uk/end_user_agreement.pdf





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