Boramae Hospital Liver Cirrhosis Patient Cohort Study
Boramae Hospital Liver Cirrhosis Patient Cohort Study
Liver cirrhosis represents a worldwide health problem and is a major cause of mortality.
 Cirrhosis is the common end for chronic alcohol abuse and hepatitis C and B virus infections.
 Patients who have cirrhosis have varying degrees of compensated liver function, and
 clinicians need to differentiate between those who have stable, compensated cirrhosis and
 those who have decompensated cirrhosis. It is shown various complications: portal
 hypertension, hepatocellular carcinoma, hepato-renal syndrome, etc.

 Thus, it is important to have this information to manage disease and determine specific
 therapy. However, register-based studies in have not been reported in Korea.

 The goal of this study is to describe the natural history of a large number of patients with
 liver cirrhosis prospectively followed, and to identify predictors of the occurrence of
 Hepatocellular carcinoma.
The investigators are planning to recruit patients with liver cirrhosis, and collect the
 baseline clinical laboratory data. Biological tests, endoscopy,liver ultrasonography
 (including ARFI) and hepatic venous pressure gradient measurements will be performed if not
 done within 90 days prior to inclusion. During this visit, 20 ml of blood will be collected
 for freezing and storage of serum and plasma, and constitution of a DNA library.

 Monitoring: Patients will have regular surveillance with blood test, liver ultrasonography
 and medical consultation at least every 6 months, periodic assessment of esophageal, gastric
 varices and portal hypertensive gastropathy (every 1 year) and prevention of their rupture if
 any. An additional blood sampling of 20 ml will be taken at baseline and every year in order
 to perform whole blood, serum, plasma, peripheral blood mononuclear cells and DNA libraries;
 Data will be standardized and centralized in a single database.

 And alcoholic liver cirrhosis patients will undergo liver biopsy for polymerase chain
 reaction, western blot, immunohistochemistry and RNA analysis.

 After measurement of hepatic venous pressure gradient and liver stiffness at baseline a
 non-selective beta-blocker (NSBB,carvedilol) was initiated and increased stepwise (weekly)
 until the systolic blood pressure remained at>100 mmHg and the heart rate was not <60. The
 maximum target dose for carvedilol 25 mg/day. The hepatic venous pressure gradient response
 to NSBB was again assessed 6 weeks after the intake of carvedilol. A hemodynamic response to
 NSBB treatment was defined as a reduction in hepatic venous pressure gradient >=20% compared
 to baseline or to an absolute value <=12 mmHg. Compliance with therapy was monitored by
 monitoring of heart rate and blood pressure during clinical visits.
Inclusion Criteria:

 -  Age ≥19years old Proven cirrhosis

 -  No previous hepatocellular carcinoma (treated or not)

 -  Signed informed consent

 Exclusion Criteria:

 -  serious associated short-term life threatening disease (except associated HIV viral
 infection and the liver disease itself)

 -  liver focal lesion suggestive of hepatocellular carcinoma

 -  patient under guardianship

 -  pregnant women

 -  inability to regular monitoring, for whatever reason