2). Thus, there was no evidence of a particular chronological pattern in the order of developing the three complications. Despite the lack of a predictable sequence of clinical events, all patients without hepatic encephalopathy had about a 25% risk of developing a complication within 1 year after entry into a given complication category, and Ganetespib molecular weight a 50% risk of developing one within 5 years (Fig. 2). We found that Danish patients with alcoholic cirrhosis most frequently presented either with ascites alone (55%) or without complications (24%). The presence and type of complications were strong predictors of 1-year mortality,

which ranged from 17% for patients without complications to 85% for patients with hepatic encephalopathy. The risk of new complications was similar for all patients.

Complications did not develop in any particular chronological NVP-BKM120 order sequence, suggesting that the clinical course of alcoholic cirrhosis is a random series of clinical events and not a predictable accumulation of complications. Our risk estimates were based on complete follow-up of a population-based patient sample under specialist care and thus are likely to generalize to alcoholic cirrhosis patients in other settings, particularly given that treatment guidelines in Western countries were already established at the beginning of our study period and follow similar principles. However, the risk estimates could

be biased if some patients did not have cirrhosis or did not have the complications. This is unlikely, based on a study of Danish alcohol-abusing men which showed that clinical cirrhosis diagnoses have a high positive predictive value when validated against biopsy findings.26 Moreover, it is highly plausible that all first-time episodes of evident ascites, selleck chemical variceal bleeding with hematemesis, and overt hepatic encephalopathy were recorded in the medical charts. The 55% prevalence of ascites at cirrhosis diagnosis among patients in our study exceeds the 30%–40% prevalence estimated in most previous studies, whereas the prevalence of the other two complications is similar to that reported in those studies.3, 6, 7, 10 The reasons for the higher prevalence of ascites in our study are unclear. A still higher prevalence was found in a Norwegian study based on 100 patients with alcoholic cirrhosis seen in a single medical department in 1984–1988.9 That study reported a 67% prevalence of ascites and a 34% prevalence of variceal bleeding at the time of cirrhosis diagnosis, and those high prevalences might be explained by selective inclusion of patients who were referred to a specialist department because of advanced disease. Our study, by contrast, was population-based and therefore not vulnerable to such an inclusion bias.