ISSN 2413-6077. IJMMR 2019 Vol. 5 Issue 140

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doI 10.11603/IJMMR.2413-6077.2019.1.9857

MORTALITY ANALYSIS OF THE PATIENTS wITH ALCOHOLIC LIvER 
CIRRHOSIS

N.R. Matkovska
IVANO-FRANKIVSK NATIONAL MEDICAL UNIVERSITY, IVANO-FRANKIVSK, UKRAINE

Background. Alcohol is considered to be the main risk factor for adverse event deaths around the world. 
In Ukraine, mortality due to alcoholic liver disease (ALD) has taken the second place in the structure of death 
causes from diseases of the digestive system.

Objective. The aim of the research was to study the peculiarities of the causes of death in the patients with 
alcoholic liver disease at the stage of liver cirrhosis (LC) based on the analysis of protocols of pathoanatomical 
research.

Methods. The analysis of 149 protocols of the pathoanatomical study of the patients, who died from alcoholic 
LC, has been carried out at the premises of the Pathoanatomical Department of the Ivano-Frankivsk Regional 
Clinical Hospital in 2006-2018. 

Results. Most people were young and middle aged. Fatal cases were caused by decompensation of the LC 
with the development of hepatic, hepatic-renal, cardio-pulmonary insufficiency, pancreatic necrosis, gastrointestinal 
bleeding (GIB), sepsis, hepatocellular carcinoma (HCC). In 37.6 % of the patients the concomitant illness was 
coronary heart disease (CHD), 10.7 % of the people had hypertension. In 6 % of the patients, ischemic stroke of 
the brain was diagnosed. In most people atherosclerotic vascular changes were revealed.

Conclusions. Excessive consumption of alcohol and, consequently, the development of LC, can be considered 
as an adverse factor in the reducing social standard of living. In the majority of people, who died from the 
decompensation of alcoholic LC, atherosclerotic vascular lesions have been detected. This indicates a significant 
prevalence of lipid metabolism disturbance in the people with alcoholic LC.

KEY WORDS: liver cirrhosis, alcoholic; cause of death; coronary disease; atherosclerosis.

Corresponding author: Natalia R. Matkovska, Ivano-Frankivsk 
National Medical University, 
16 Kropyvnytskyi str., Ivano-Frankivsk 76018
e-mail: nmail4you@gmail.com 

Introduction
Demographic processes in Ukraine have 

signs of a protracted demographic crisis, which 
is closely related to the historical and socio-
economic peculiarities of the country's deve-
lopment. It is well-known that Ukraine belongs 
to countries with a progressive decline in 
demographic and reproductive potential, which 
leads to depopulation and population decline. 
At the beginning of 2016, the number of child-
ren in the population of Ukraine was 16.1 %, 
those of working age – 61.8 %, older than able-
bodied – 22.1 %. The prevalence of women in 
the elderly as a result of higher mortality among 
males is the peculiarity of gender imbalance. 
Demographic aging, that is, the steady increase 
in the proportion of economically and socially 
inactive elderly people, combined with a de-
crease in the proportion of able-bodied people, 
has a direct impact on various spheres of life in 
the Ukrainian society [1, 2].

Along with the aging of the population, the 
increase in the mortality rate, which is associated 
with endogenous diseases (circulatory and 
neoplastic diseases) and exogenous (respiratory 
diseases, digestive disorders, infectious and 
parasitic diseases, external) causes, is a topical 
issue. In recent years, much attention has been 
paid to the increase in the incidence of so-called 
non-infectious diseases, which is becoming a 
sign of not only an epidemic, but also a possible 
future pandemic [3, 4, 5]. According to the wHO, 
41 million people die from these diseases every 
year, accounting for 71% of all deaths in the 
world. Annually 15 million people between 30 
and 69 years of age die from them. Cardio vas-
cular diseases (stroke, heart attack) and malig-
nant neoplasms are leading in prevalence and 
mortality among non-infectious diseases [6, 7].

Non-communicable diseases are the result 
of the combination of genetic, physiological, 
environmental and behavioural factors. Beha-
vioural factors belong to the modified factors, 
and they can be changed. These include the use 
of tobacco, lack of physical activity, inappropriate 
nutrition, and alcohol abuse. The other not less 

International Journal of Medicine and Medical Research 
2019, Volume 5, Issue 1, p. 40-46
copyright © 2019, TNMU, All Rights Reserved

N.R. Matkovska



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important factors include metabolic factors: 
increased blood pressure, overweight/obesity, 
hyperglycemia, hyperlipidemia [8, 9, 10]. 

Among non-infectious diseases caused by 
these risk factors, the digestive diseases 
together with the increase of the proportion of 
deaths are significant. Fibrosis and LC, alcohol 
and non-alcoholic liver diseases, which accounts 
for more than 50 % of those who died of di-
gestive diseases, contributed much to mortality 
from this class of deaths causes. The reasons 
for this are the continuous increase of quan-
titative and qualitative types of such patients, 
frequent chronic diseases, prolonged and 
severe courses, unfavourable consequences of 
a disease, prevailing affection of people of 
working age that is associated with medical and 
socio-economic factors [11, 12, 13].

The main causes of liver damage are alco-
hol, viruses, non-alcoholic fatty liver disease. 
Alcohol is considered to be the main risk factor 
for adverse lethal outcomes around the world. 
Alcohol abuse is third among the causes of 
mortality among young people after tobacco 
and arterial hypertension and secondarily 
among the causes of liver transplantation in 
Europe. In Ukraine, mortality due to ALD takes 
the second place in the structure of causes of 
death from digestive diseases [14, 15, 16].

The aim of the research was to study the 
peculiar features of the death causes in the 
patients with ALD at the stage of LC based on 
the analysis of protocols of pathoanatomical 
investigation.

Methods
The analysis of 149 protocols of patho-

anatomical research of the patients, who died 
from alcoholic LC at the premicies of the 
Pathoanatomical Department of the Ivano-
Frankivsk Regional Clinical Hospital in 2006-
2018, was conducted. The average age of pa-
tients was (56±12.1) years old (y. o.): women – 

(44.6±9.2) y. o., men – (57.6±11.8) y. o., the 
average duration of the disease was (6.6±1.8) 
years. The patients were divided into groups by 
age as follows: 44 young people (31 males and 
13 females), 76 middle-aged persons (64 males, 
12 females), 29 elderly patients (19 males, 10 
females).

Results
According to the Child-Pugh criteria, among 

the patients with the LC, who died, there are 9 
(6%) persons with stage A of the disease, 26 
(17.5%) – with stage B, 114 (76.5%) persons – 
with stage C. The causes of death in the patients 
with the LC of alcoholic etiology were pancreatic 
necrosis (4.7 % of patients with stage A, 8.8 % 
of patients with stage B and 1.3 % of patients 
with stage C), gastrointestinal bleeding (GIB) – 
in 4 % of patients with stage B and in 36.3 % of 
patients with stage C, liver failure – in 17.4 % of 
patients with stage C, liver and kidney failure – 
in 1.3 % of people with stage B and in 10.7 % of 
persons with stage C, sepsis – in 1.3 % of 
patients with stage B and in 6.7 % of patients 
with stage C, cardio-pulmonary insufficiency – 
in 1.3 % of patients with stage A and 2 % of 
patients with stage B, HCC – in 4 % of people 
with stage C (Table 1).

According to the medical records, in all 
patients who died, the signs of portal hyper-
tension, hepatosplenomegaly, cytolytic, hepa-
todepressive, mesenchymal-inflammatory 
syndrome were revealed. Among the manifes-
tations of hepatic hyperazotemia there were 
hepatic encephalopathy and hepatopulmonary 
syndrome in all patients and hepatorenal 
syndrome – in 87.9 % (3.4 %, 10.7 %, 4.7 % of 
cases in young, middle aged and elderly 
patients), respectively. The signs of cholestasis 
syndrome were detected in 88.6 % of patients.

Excessive subcutaneous fat was in 34.9 % 
of cases, satisfactory – in 42.3 %, insufficient – in 
22.8 %. 134 (89.9 %) patients had ascites; 18.1 

Table 1. Death causes in the patients with liver cirrhosis

Death causes

Stage of Child-Pugh criteria 
А

(n=9)
В

(n=26)
С

(n=114)
n % n % n %

Pancreatic necrosis 7 4.7 13 8.8 2 1.3
Gastrointestinal bleeding - - 6 4 54 36.3
Liver failure - - - - 26 17.4
Liver and kidney failure - - 2 1.3 16 10.7
Sepsis - - 2 1.3 10 6.7
Cardio-pulmonary insufficiency 2 1.3 3 2 - -
Hepatocellular carcinoma - - - - 6 4

N.R. Matkovska



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% of them suffered from ascites-peritonitis. 
Septicemic condition was revealed in 8.7 % of 
cases and steatonecrosis of the omentum – in 
16.1 % of people. Hydrotorax was diagnosed in 
83.2 % of cases, hydropericardium – in all cases. 
Varicose of the oesophagus veins was diagnosed 
in all the lethal outcomes: of the 1st stage – in 
9.4 % (14 persons), 2nd stage – in 20.8 % (31 
persons), 3rd stage – in 69.8 % (104 persons) of 
cases, varicose veins of the stomach were 
present in 40.9 % of cases. The bleeding from 
varicose veins of the oesophagus was in 57.7 %, 
a combination of bleeding from the veins of the 
oesophagus and the stomach – in 30.2 % of 
cases. Depending on the age, the GIB was in 
10.7 %, 18.8 %, 6.7 % of the patients of young, 
middle and old age, respectively. Among men, 
GIB was revealed in 35.5 % of young people, in 
35.9 % of middle-aged patients, in 15.4 % of the 
elderly. Among women, GIB was revealed in 
38.5 % of young people, in 41.7 % of middle-
aged patients and 30 % of the elderly (Table 2).

Erosive gastroduodenitis was revealed in 
66.4 % (99 persons) of cases, acute ulcers of the 
duodenal bulb (DB) – in 10.7 % (16 persons), 
acute ulcers of the stomach – in 2.7 % (4 persons). 
The umbilical hernia was present in 12.7 % of 
cases. Chronic hemorrhoids were diagnosed in 
10.7 % of people (with bleeding in 4.7 % of 
cases).

Mild anemia was evidenced in 14.1 % of 
patients, moderate – in 39.6 %, severe – in 
49.7 %. In 86.6 % of cases, the signs of chronic 
pancreatitis were revealed, 55 % of patients had 
pancreatic lipodystrophy, 14.8 % suffered from 
pancreatic necrosis (young and middle-aged 
persons), 7.4 % had cholelithiasis, 61.7 % – the 
signs of chronic cholecystitis, in 2 % of people 
the signs of cholangitis were present. Hypotonia 
of the gall bladder was revealed in 12.1 % of all 
cases.

Type 1 diabetes mellitus was diagnosed in 
2 % of young people, type 2 – in 4.7 % of middle-
aged and elderly people. Chronic pyelonephritis 

Table 2. The revealed pathoanatomical changes of internal organs depending  
on the liver cirrhosis decompensation stage

Pathological changes of internal organs
Stage by Child-Pugh criteria

А В С
n % n % n %
9 6 26 17.5 114 76.5

Cardiovascular system:
- hydropericardium
- hypertension
- IHD
- atrial fibrillation
- ischemic stroke of the brain in anamnesis
- chronic venous insufficiency of the vessels of the 
lower extremities
- atherosclerosis of the coronary arteries

-- stage of the lipid stain
-- stage of atherosclerotic plaque
-- complicated plaque with ulceration
-- narrowing of LCA by 10%
-- narrowing of LCA by 30%
-- narrowing of LCA by 50%

- atherosclerosis of the iliac arteries
-- stage of the lipid stain
-- stage of atherosclerotic plaque

- atherosclerotic changes in the aorta
-- stage of the lipid stain
-- stage of atherosclerotic plaque
-- complicated plaque with ulceration

9
6
3
-
3
-

9
2
5
-
3
3
-
4
-
4
9
2
4
3

6
4
2
-
2
-

6
1.3
3.4
-
2
2
-

2.7
-

2.7
6

1.3
2.7
2

26
8

22
3
6
-

24
10
10
4
3
2
3
8
6
2

26
9

12
5

17.5
5.4

14.8
2
4
-

16.1
6.7
6.7
2.7
2

1.3
2

5.3
4

1.3
17.5

6
8

3.4

114
2

31
2
-
7

22
5

17
-
2
2
-
5
5
-

84
36
42
6

76.5
1.3

20.8
1.3
-

4.7

14.8
3.4

11.5
-

1.3
1.3
-

3.4
3.4
-

56.4
24.2
28.2

4

Respiratory system:
- hydrothorax
- pulmonary edema
- pulmonary emphysema
- pneumonia
- pleurisy
- CORP

-
9
-
-
-
-

-
6
-
-
-
-

10
26
2
7
6
3

6.7
17.5
1.3
4.7
4
2

114
114

4
98
35
8

76.5
76.5
2.7

65.8
23,5
5.4

N.R. Matkovska



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Pathological changes of internal organs
Stage by Child-Pugh criteria

А В С
n % n % n %
9 6 26 17.5 114 76.5

Digestive system:
- portal hypertension
- cytolytic syndrome
- hepatodepressive syndrome 
- mesenchymal-inflammatory syndrome 
- cholestasis syndrome 
- ascites
- ascites-peritonitis 
- steatonecrosis of the omentum 
- splenomegaly
- umbilical hernia 
- varicose of the esophagus veins

1-st degree
2-nd degree
3-d degree

-- with bleeding
- varicose veins of the stomach

-- with bleeding
- erosive gastroduodenitis 
- acute ulcers of the duodenal bulb
- acute ulcers of the stomach 
- chronic hemorrhoids
- hemorrhoidal bleeding
- chronic pancreatitis
- pancreatic lipodystrophy
- pancreatic necrosis
- cholelithiasis
- chronic cholecystitis
- cholangitis
- hypotonia of the gall bladder
- type 1 diabetes mellitus
- type 2 diabetes mellitus

9
9
9
9
-
-
-
-
9
-
9
9
-
-
-
-
-
-
-
-
-
-
-
-

10
2
-
-
-
-
-

6
6
6
6
-
-
-
-
6
-
6
6
-
-
-
-
-
-
-
-
-
-
-
-

6.7
1.3
-
-
-
-
-

26
26
26
26
18
20
-
-

26
-

26
5

21
-
-
-
-
8
-
-
3
-

15
6
8
5

16
-
-
-
2

17.5
17.5
17.5
17.5
12.1
13.4

-
-

17.5
-

17.5
3,4

14.1
-
-
-
-

5.3
-
-
2
-

10.1
4

5.4
3.4

10.7
-
-
-

1.3

114
114
114
114
114
114
27
24

114
19

114
-

10
104
86
61
45
91
16
4

13
7

114
76
4
4

76
3

18
3
5

76.5
76.5
76.5
76.5
87.9
86.6
18.1
16.1
76.5
12.7
76.5

-
6.7

69.8
57.7
40.9
30.2
61.1
10.7
2.7
8.7
4.7

76.5
51
2.7
2.7
51
2

12.1
2

3.4

Urinary system:
- chronic pyelonephritis 
- kidney cyst

-
-

-
-

2
-

1.3
-

12
3

8.1
2

Nervous system:
- encephalopathy
- alcoholic delirium in anamnesis

9
7

6
4.7

26
4

17.5
2.7

114
-

76.5
-

was present in 9.4 % of cases, kidney cyst – 
in 2 %.

Pneumonia was diagnosed in 70.5 %, 
pleurisy – in 27.5 %, chronic obstructive pul-
monary disease (COPD) – in 7.4 %, pulmonary 
emphysema – in 4 %. In 4.7 %, chronic venous 
insufficiency of the vessels of the lower 
extremities was revealed.

Among the concomitant diseases, hyper-
tension was present in 10.7 % of middle aged 
and elderly patients, ischemic heart disease 
(IHD) – in 37.6 % of cases, 3.4 % of these patients 
suffered from atrial fibrillation. 6 % of patients 
had ischemic stroke of the brain in anamnesis, 
and 7.4 % – alcoholic delirium. The signs of 
atherosclerosis were also evidenced. Particu-

larly, the biochemical parameters of the lipid 
spectrum were characterized by an increase in 
the content of total cholesterol in the blood, 
low and very low-density lipoprotein cholesterol. 
Moreover, the degree of increase of these 
indicators was directly proportional to the 
degree of decompensation of LC.

Atherosclerotic changes in the aorta at the 
stage of lipid stain were present in 31.5 % of 
cases, at the stage of atherosclerotic plaque – in 
38.9 %, at the stage of complicated plaque with 
ulceration – in 9.4 % of people. Atherosclerosis 
of the left coronary artery (LCA) was revealed 
in 11.4 % at the lipid staining stage, at the stage 
of atherosclerotic plaque – in 21.5 %, ulcerated 
atherosclerotic plaque was present in 2.7 %. 

N.R. Matkovska



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Narrowing of LCA by 10% was revealed in 5.3 % 
of cases, by 30 % – in 4.7 %, by 50 % – in 2 %. 
Atherosclerosis of iliac arteries was present in 
11.4 % of patients.

Discussion
Consequently, analyzing clinical records of 

the pathoanatomical study of the patients with 
alcoholic LC, it was established that most 
patients were young and middle aged and died 
from decompensated LC with the development 
of multiple organ failure. In all cases, there was 
a lesion of the pancreas, in half of them lipo-
dystrophy was revealed. Bleeding from varicose 
veins of the esophagus and stomach was the 
cause of death in 57.5 % of people, 14.8 % of 
patients died from pancreatic necrosis, 4 % – 
from HCC. IHD was the concomitant illness in 
37.6 % of the patients. More than 70 % of the 
dead had atherosclerotic lesions of aorta, and 
one third of the persons had injured coronary 
vessels.

Excessive consumption of alcohol and, 
consequently, the development of LC, can be 
considered as an adverse factor in the reducing 
social standard of living. Fatal cases were 
caused by decompensation of LC, development 
of multiple organ failure, pancreatic necrosis, 
bleeding from the esophagus and stomach 
veins, HCC. Special attention should be paid to 
the combination of ALD with atherosclerotic 
vascular changes revealed in 79.8 % of people, 
indicating a significant prevalence of lipid 
metabolism disorders among people with 
decompensated alcoholic LC.

Consequently, analyzing clinical records of 
the pathoanatomical study of the patients with 
alcoholic LC, it was established that most 
patients were young and middle aged and died 
from decompensated LC with the development 
of multiple organ failure. In all cases, a lesion 
of the pancreas was present, in half of them 
pancreatic lipodystrophy was revealed. The 
cause of death in 40.3 % of people was bleeding 
from varicose veins of the esophagus and 
stomach with subcompensation and decom-
pensation of LC, 17,4 % of patients died from 
hepatic failure with decompensation of LC, 13.5 
% of patients died from pancreatic necrosis with 
compensation and subcompensation of LC. 
Hepatic-renal failure was cause of death of the 
patients with subcompensation and decom-
pensation of LC. Sepsis caused death of 8 % of 
people with subcompensation and decom-

pensation of LC, 4 % of patients died from HCC. 
Cardio-pulmonary failure caused death in the 
patients with compensation and subcom-
pensation of LC. 

The cytolytic, hepato-depressive, mesen-
chymal-inflammatory, hepatic encephalopathy, 
cholestatic, hepatorenal, anemic, hepa topul-
monary syndromes and portal hyper tension 
were especially significant in the patient with 
subcompensation and decompensation of LC. 

More than a third of people had over-
developed subcutaneous fat. IHD was the 
concomitant illness in 37.6 % of the patients. 
More than 70 % of the dead had atherosclerotic 
lesions of aorta, and one third of the persons 
had injured coronary vessels.

Excessive consumption of alcohol and, 
consequently, the development of LC, can be 
considered as an adverse factor in the reducing 
social standard of living. Fatal cases were 
caused by decompensation of LC, development 
of multiple organ failure, pancreatic necrosis, 
bleeding from the esophagus and stomach 
veins, HCC. Special attention should be paid to 
the combination of ALD with atherosclerotic 
vascular changes revealed in 79.8 % of people, 
indicating a significant prevalence of lipid 
metabolism disorders among people with 
decompensated alcoholic LC.

Conclusions
Analyzing clinical records of the patho-

anatomical study of the patients with alcoholic 
liver cirrhosis, it was established that most 
patients were young and middle aged and died 
from decompensated LC with the development 
of multiple organ failure. Bleeding from 
varicose veins of the esophagus and stomach 
were the causes of death in 57.5 % of people, 
14.8 % of patients died from pancreatic necrosis, 
4 %– from HCC. IHD was the concomitant illness 
in 37.6 % of the patients. More than 70% of the 
dead had atherosclerotic lesions of aorta, and 
one third of the persons had injured coronary 
vessels. Pancreatic necrosis and cardio-pul-
monary failure were the causes of death in most 
people with stages A and B. GIB, hepatic and 
hepatic-renal failure, sepsis, and development 
of HCC were the causes of death in most people 
with stage C. IHD was the concomitant illness 
in 37.6 % of the patients. 

Conflict of interest
The author declares no conflict of interest.

N.R. Matkovska



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АНАЛІз СМЕРТНОСТІ ХВОРИХ НА АЛКОГОЛЬНИй ЦИРОз ПЕЧІНКИ

Н.Р. Матковська
ДВНЗ “ІВАНО-ФРАНКІВСьКий НАцІОНАЛьНий МЕДиЧНий УНІВЕРСиТЕТ”, 

ІВАНО-ФРАНКІВСьК, УКРАїНА

Вступ. Алкоголь визнають основним фактором ризику несприятливих летальних завершень у 
всьому світі. В Україні смертність внаслідок алкогольної хвороби печінки (АХП) посіла друге місце в 
структурі причин смерті від хвороб органів травлення.

Мета. Метою було вивчити особливості причин смерті у осіб з АХП на стадії цирозу печінки (цП) 
на основі аналізу протоколів патологоанатомічного дослідження.

Методи. Проведено аналіз 149 протоколів патологоанатомічного дослідження померлих на 
алкогольний цП на базі патологоанатомічного відділення Івано-Франківської обласної клінічної лікарні 
за період 2006-2018 рр.

Результати. Більшість осіб були молодого та середнього віку. Летальні випадки були зумовлені 
декомпенсацією цП з розвитком печінкової, печінково-ниркової, серцево-легеневої недостатності, 
панкреонекрозу, шлунково-кишкових кровотеч, сепсису, гепатоцелюлярної карциноми. У 37,6% померлих 
супутньою хворобою була ішемічна хвороба серця, у 10,7% осіб – гіпертонічна хвороба. У 6% осіб в 
анамнезі був перенесений ішемічний інсульт головного мозку. У більшості осіб виявлено атеросклеротичні 
зміни судин.

Висновки. Надмірне вживання алкоголю і, як наслідок, розвиток цирозу печінки можна вважати 
несприятливим чинником зниження рівня здоров’я населення. У більшості осіб, що померли внаслідок 
декомпенсації алкогольного виявлено атеросклеротичні ураження судин. це вказує на значну 
поширеність порушення ліпідного обміну у осіб з алкогольним цирозом печінки.

КЛЮЧОВІ СЛОВА: алкогольний цироз печінки; причини смерті; ішемічна хвороба серця; 
атеросклероз.

Інформація про автора
Матковська Наталія Романівна – доцент кафедри терапії і сімейної медицини післядипломної 
освіти, канд. мед. наук, ДВНЗ “Івано-Франківський національний медичний університет”, 
вул. Кропивницького, 16, м. Івано-Франківськ, 76018.

Information about the author
Natalia R. Matkovska – MD, Ph.D, Assosiate Professor of the Department of Therapy and Family
Practice of postgraduate study faculty, Ivano-Frankivsk National Medical University,
16 Kropyvnytskyi str., Ivano-Frankivsk, 76018.
ORCID 0000-0002-9924-2127, e-mail: nmail4you@gmail.com

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Received 19 February 2019; revised 18 March 2019; 
accepted 12 April 2019

This is an open access article distributed under the Creative 
Commons Attribution License, which permits unrestricted use, 
distribution, and reproduction in any medium, provided the 
original work is properly cited. 

N.R. Matkovska