Original articles—liver, pancreas, and biliary tractUse of Over-the-Counter Analgesics Is Not Associated With Acute Decompensation in Patients With Cirrhosis
Section snippets
Study Design
The study was designed as a case-control study in which consecutive unique patients with cirrhosis hospitalized for “acute hepatic decompensation” (cirrhotic cases) between August 2000 and May 2002 were compared with consecutive patients with cirrhosis who had not been hospitalized in the previous 3 months and in the month following enrollment (cirrhotic controls) and with patients without cirrhosis hospitalized at the same time as the cases (noncirrhotic controls). Cases were identified
Patient Characteristics
In the period between August 2000 and May 2002 (end of the study), 333 patients were enrolled: 91 cirrhotic cases, 153 cirrhotic controls, and 89 noncirrhotic controls. Forty-five cases could be matched by age and CTP class to 45 cirrhotic controls.
Table 1 shows the demographic characteristics of patients included in the study. Among cirrhotic cases, alcohol was the most common etiology, while among cirrhotic controls viral hepatitis (hepatitis C or B) was the most common etiology. Liver
Discussion
Decompensated cirrhosis is defined by the development of ascites, variceal hemorrhage, encephalopathy, or jaundice. It is at this stage of cirrhosis that the patient is at risk of dying from liver disease.6 Patients with cirrhosis are usually hospitalized when the first episode of decompensation occurs or when an already decompensated patient deteriorates further. A superimposed acute injury (acute-on-chronic event) can precipitate decompensation in the compensated patient or lead to further
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This article has an accompanying continuing medical education activity on page 914. Learning Objectives—At the end of this activity the learner should identify the role of acetaminophen use and use of nonsteroidal drugs in promoting decompensation of liver disease in patients with cirrhosis.
Conflicts of interest The authors disclose no conflicts.
Funding This project was supported in part by grant from McNeil Pharmaceuticals and the Clinical Core of the Yale Liver Center NIDDK P30-34989.