Etiological Spectrum, Epidemiological Characteristics in Compensated and Decompensated Cirrhosis at First Presentation

Abstract

ABSTRACT Context and Aim: Decompensation as a presenting feature is uncommon among cirrhosis-seeking consultations and may indicate the poor outcomes. This study will be assessing the etiology and epidemiological characteristics among compensated and decompensated cirrhosis at first presentation. Settings and Design: A cross-sectional study in a tertiary care hospital in south Kerala, India. Subjects and Methods: Two hundred and nine patients with liver cirrhosis were evaluated for: age at presentation to the hospital, biochemical, virologic, Child–Pugh and Model for end-stage liver disease (MELD), and MELD Sodium (MELD Na) scores. Using cutoff for MELD Na and Child scores A versus B and C, the degree of association in those with or without decompensation was evaluated. Results: The mean (standard deviation) age of participants was 58.24 (±9.9) years. Seventy-seven percent were males. 11.5% were with decompensated cirrhosis (DC). 61.2% had alcoholic liver disease (ALD); 8.1% had hepatitis B; 2.4% hepatitis C virus; 0.5% autoimmune hepatitis; and 27.8% had nonalcoholic steatohepatitis (NASH). In compensated cirrhosis (CC), 60.5% had ALD and 28.1% (n = 52) had NASH, whereas, in those with decompensation, 66.7% had ALD and 25% had NASH. In CC, 54.1% were Child A and the rest B and C compared to DC, wherein 58.3% were with Child B and C and 41.7% in Child A. MELD Score of 9+ was more in DC compared to CC (P = 0.05). Alcoholic hepatitis was observed in 32% of DC. Conclusions: Decompensation was the presenting feature in 11.5%, and alcohol abuse was the major risk factor. Those with DC have higher MELD scores.