Survival in alcoholic liver cirrhosis: prognostic value of portal pressure, size of esophageal varices and biochemical data. Comparison with Child classification.
A survival analysis was carried out based on the data of 190 male patients with alcoholic liver cirrhosis (Child A: 82.2%; Child B: 17.8%). Patients (mean age: 49.6 +/- 7.1 years) were examined during the period 1983-1990. Censoring in May 1993 was based on the recordings of the "Rentenversicherungsanstalten". There were no "drop-outs". During follow-up (mean: 4.2 years) 64 (33.7%) of the patients died. 13 potential prognostic variables were examined individually by drawing Kaplan-Meier curves and performing log-rank tests. Portal pressure, determined during hepatic vein catheterization as hepatic vein pressure gradient HVPG (P), size of esophageal varices, serum bilirubin, serum albumin, prothrombin time (Quick), thromboplastin time (PTT), cholinesterase (ChE) and Child scores were correlated to survival (p < 0.05), whereas age, gamma GT, IgA, drinking habits and additional diagnoses were not. A multivariate Cox regression analysis stepwise eliminated all but three variables: ChE, albumin and variceal size were included in the prognostic index PI of the final model. The usefulness of the model was tested by a cross validation method. No significant difference was found between estimated and observed survivorship functions. To compare the PI of the Cox model with Child's scores, ROC curves of sensitivity and specificity of predicting death within one, three and five years were constructed. Better prognostic efficiency was indicated for PI. Because ChE, albumin and the size of varices are determined as a routine in our clinic, we consider the construction of PI an advisable alternative to Child's classification.