1 and 5 year survival estimates for people with cirrhosis of the liver in England, 1998-2009: a large population study

J Hepatol. 2014 Feb;60(2):282-9. doi: 10.1016/j.jhep.2013.09.027. Epub 2013 Oct 12.


Background & aims: Large, population-based studies that have included the full spectrum of cirrhosis estimating survival, taking into account time-at-risk are lacking. We aimed to report 1- and 5-year average survival rates for people with cirrhosis to be used in a clinical and healthcare policy setting.

Methods: We used the Clinical Practice Research Datalink and linked English Hospital Episode Statistics to identify adult cases of cirrhosis from January 1998 to December 2009. We estimated 1- and 5-year survival according to whether time-at-risk was ambulatory or followed an emergency hospital admission related to liver disease, stratified by age, sex, and aetiology to be used in a clinical setting. We used a multivariate Cox-proportional hazards model with a time-varying variable, adjusted for Baveno IV stage of cirrhosis at diagnosis, age, aetiology, and sex.

Results: We identified 5118 incident cases. Average survival probabilities at 1- and 5-years were 0.84 (95% CI 0.83-0.86) and 0.66 (95% CI 0.63-0.68) for the ambulatory group and 0.55 (95% CI 0.53-0.57) and 0.31 (95% CI 0.29-0.33) following hospitalisation, respectively. A hospital admission at diagnosis or subsequently for liver disease substantially impaired prognosis independent of stage of cirrhosis (HR=2.78, 95% CI 2.53, 3.06).

Conclusions: Emergency hospitalisation for liver disease heralds a downturn in a patient's outlook independent of their stage of cirrhosis. Our results provide population-based clinically translatable estimates of prognosis for the purposes of healthcare delivery and planning and communication to patients.

Keywords: Aetiology; CPRD; Cirrhosis; Clinical Practise Research Datalink; HES; Hospital Episode Statistics; ICD10; International Classification of Disease 10th version; ONS; OPCS4; Office of National Statistics; Office of Population Censuses and Surveys’ classification of interventions and procedures 4th version; Population-based; Survival; UTS; up to standard.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Databases, Factual
  • England / epidemiology
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Liver Cirrhosis / etiology
  • Liver Cirrhosis / mortality*
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Prognosis
  • Proportional Hazards Models
  • Risk Factors
  • Time Factors