Abstract
Current knowledge of cirrhosis progression is derived from outdated data. We examined the progression patterns of cirrhosis in a contemporary cohort. We conducted a retrospective cohort study of adult patients diagnosed with compensated cirrhosis at 130 Veterans Affairs healthcare facilities from 10/1/2010 to 08/30/2015, with follow-up through 08/31/2023. A semi-Markov multistate model with 7 states and 15 transitions was used to evaluate progression from compensated cirrhosis to ascites, hepatic encephalopathy, variceal bleeding, hepatocellular carcinoma (HCC), multiple complications, or death, considering age and etiology (cured/active HCV, alcohol, metabolic dysfunction-associated steatotic liver disease [MASLD]) as time-varying factors. Results: We identified 24,679 patients with compensated cirrhosis. Over a median follow-up of 5.3 years, 49.8% progressed to a single complication, with ascites (30.3%) being the most common, and 3.1% progressed to multiple complications. A total of 12.9% transitioned directly to death from non-liver-related causes, while 26% remained compensated. The two-year risk of transitioning to death was 13.5%, exceeding the risk of any complication state. Younger patients and those with alcohol-related cirrhosis had faster progression, while older patients and those with active HCV had a higher incidence of HCC. Transition rates were similar for patients with alcohol and MASLD. In a contemporary cirrhosis cohort, half of patients progressed, while others remain compensated, and a large fraction transitioned directly to death, with age and etiology significantly influencing outcomes. These data highlight the importance of interventions in the high-yield period before the first complication.
Published Version
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