The galactose elimination capacity and mortality in 781 Danish patients with newly-diagnosed liver cirrhosis: a cohort study

Peter Jepsen,Niels Tygstrup,Susanne Keiding,Hendrik Vilstrup,Per K Andersen,Peter Ott

doi:10.1186/1471-230x-9-50

Abstract

BackgroundDespite its biologic plausibility, the association between liver function and mortality of patients with chronic liver disease is not well supported by data. Therefore, we examined whether the galactose elimination capacity (GEC), a physiological measure of the total metabolic capacity of the liver, was associated with mortality in a large cohort of patients with newly-diagnosed cirrhosis.MethodsBy combining data from a GEC database with data from healthcare registries we identified cirrhosis patients with a GEC test at the time of cirrhosis diagnosis in 1992–2005. We divided the patients into 10 equal-sized groups according to GEC and calculated all-cause mortality as well as cirrhosis-related and not cirrhosis-related mortality for each group. Cox regression was used to adjust the association between GEC and all-cause mortality for confounding by age, gender and comorbidity, measured by the Charlson comorbidity index.ResultsWe included 781 patients, and 454 (58%) of them died during 2,617 years of follow-up. Among the 75% of patients with a decreased GEC (<1.75 mmol/min), GEC was a strong predictor of 30-day, 1-year, and 5-year mortality, and this could not be explained by confounding (crude hazard ratio for a 0.5 mmol/min GEC increase = 0.74, 95% CI 0.59–0.92; adjusted hazard ratio = 0.64, 95% CI 0.51–0.81). Further analyses showed that the association between GEC and mortality was identical for patients with alcoholic or non-alcoholic cirrhosis etiology, that it also existed among patients with comorbidity, and that GEC was only a predictor of cirrhosis-related mortality. Among the 25% of patients with a GEC in the normal range (≥ 1.75 mmol/min), GEC was only weakly associated with mortality (crude hazard ratio = 0.79, 95% CI 0.59–1.05; adjusted hazard ratio = 0.80, 95% CI 0.60–1.08).ConclusionAmong patients with newly-diagnosed cirrhosis and a decreased GEC, the GEC was a strong predictor of short- and long-term all-cause and cirrhosis-related mortality. These findings support the expectation that loss of liver function increases mortality.

Highlights

IntroductionThe association between liver function and mortality of patients with chronic liver disease is not well supported by data
Despite its biologic plausibility, the association between liver function and mortality of patients with chronic liver disease is not well supported by data
Cox proportional hazards regression In order to examine whether the association between galactose elimination capacity (GEC) and mortality was confounded, we estimated the hazard ratio associated with a 0.5 mmol/min GEC increase before and after adjustment for gender, age at GEC test, and presence of comorbidity

Summary

Introduction

The association between liver function and mortality of patients with chronic liver disease is not well supported by data. We examined whether the galactose elimination capacity (GEC), a physiological measure of the total metabolic capacity of the liver, was associated with mortality in a large cohort of patients with newlydiagnosed cirrhosis. Cirrhosis is a chronic liver disease with high mortality [1]. Clinicians often use scores based on standard blood chemistry tests and clinical signs of liver disease, such as the Child-Pugh score and the MELDscore, as prognostic indicators [2]. These scores reflect symptoms and complications of the liver disease, not the liver function as such. GEC is assumed to reflect the liver's total capacity to serve the vitally important metabolic homeostasis of the organism [3,4]

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