Ätiologie und Komplikationen der Leberzirrhose: Daten eines deutschen Zentrums

Background: Liver cirrhosis develops as a terminal complication of chronic liver disease. The clinical course is determined by the underlying etiology and the accompanying risk factors, which are influenced by the geographic and cultural background. Methods: A total of 236 patients (159 men, 77 women, median age 57 [22-81] years) were included for retrospective analysis between July 2012 and February 2014 using standardized questionnaires during an outpatient visit at a hepatology clinic. Results: The most common etiologies of liver cirrhosis were related to alcohol consumption (52%), chronic hepatitis C (28%) or hepatitis B (14%) infection and NASH (nonalcoholic steatohepatitis, 6%). At the time of presentation 55% patients had compensated cirrhosis corresponding to Child-Turcotte-Pugh (CTP) stage A, while 45% were in a decompensated stage (30% CTP B and 15% CTP C). Subgroups were analyzed for the incidence of complications and the emergence of infections. Most frequently esophageal varices (60%) and ascites (49%) were observed, followed by pleural effusion (14%), hepatic encephalopathy (25%) or hepatorenal syndrome (18%). 16% of patients exhibited infection based on clinical criteria. An infective agent was isolated in 38% of all cases with infection and of those 50% were gram positive bacteria. In multivariate analysis only the presence of ascites was an independent risk factor for infection. Conclusion: Despite improved medical therapies for viral hepatitis, these were the most frequent causes of liver cirrhosis, closely followed by alcoholic cirrhosis. The observed complications included bacterial infection and complication related to portal hypertension.