A possible explanation for this apparent lack of improvement in clinical management of cirrhosis is the 47% prevalence among our patients of comorbidities or complications other than those we considered in our analysis. Comorbidity has recently been demonstrated to increase both all-cause and cirrhosis-related mortality,27 and its importance is corroborated by the observation Alectinib supplier that a quarter of our patients did not die from cirrhosis, compared with 15%–20% in the older studies.3, 7 Differences in alcohol consumption also may be of importance; the proportion of abstainers in our cohort matched that in the older studies, but in those studies only complete

teetotalers counted as abstainers.3, 7 Among patients in our study, mortality increased further following the development RG7420 nmr of complications, in accordance with the existing

literature.28 Probably the higher proportion of persistent drinkers among patients with complications contributed to this association. Mortality among patients with variceal bleeding has previously been found to be similar in those with and without a history of ascites,28 but our results and those from a recent German study demonstrate that this is not the case.29 A likely explanation for the emerging importance of ascites among patients with variceal bleeding is that bleeding is less fatal now than it was in the past.30 In fact, the mortality of patients with complications was consistently lower in our study than in older studies.3, 6, 7, 10, 31 The largest earlier study, including 122 Spanish patients with alcoholic cirrhosis and 171 patients with nonalcoholic cirrhosis,11 reported that the risk of developing ascites, variceal bleeding, or hepatic encephalopathy increased steadily by 7%–10% per year in the cohort as a whole.11–14 This is consistent with our finding that 49% of patients without complications at cirrhosis diagnosis developed medchemexpress complications within 5 years. At the same time, the risk in our study was much higher during

the first year (22%) than during the following 4 years (27%, or about 7% per year). In the Spanish study, patients were not included when the clinical diagnosis was made, but when it had been confirmed by a liver biopsy in a specialist unit.11 However, patients at highest risk of complications may not have survived from clinical diagnosis to inclusion, and the risk of complications could therefore have been underestimated. Furthermore, although our study corroborates previous findings that ascites is usually the first complication to appear,11, 28 we also found a high risk of variceal bleeding or hepatic encephalopathy as the first complication. This indicates that patients with alcoholic liver cirrhosis should always be considered at risk of all three complications.