Hypergammaglobulinemia is a strong predictor of disease progression, hepatocellular carcinoma development and death in patients with compensated cirrhosis

Cirrhosis represents the end stage of chronic liver disease (CLD) due to different causes. In addition, cirrhosis itself is largely the most important risk factor for the development of hepatocellular carcinoma (HCC). The natural history of cirrhosis is characterized by an asymptomatic phase, termed ‘compensated’ cirrhosis followed by a rapidly progressive phase termed ‘decompensated cirrhosis. Although many prognostic models have been proposed in the last two decades to predict mortality in cirrhosis, the Child–Pugh score is by far the most largely used both in clinical practice and in clinical research. Indeed, patients in C-P class A (compensated phase) usually have a mild and often totally asymptomatic disease that may either be clinically stable over time or may quite rapidly progress towards C-P class B and C and/or to HCC development, finally leading to death. The lack of reliable and routinely available predictors makes it difficult to foresee the clinical outcome in many patients with compensated C-P class A cirrhosis. The aim of this study was to evaluate the clinical/biochemical/ultrasonographic/endoscopic parameters at the time of diagnosis and during the subsequent long-lasting follow-up in patients with C-P class A cirrhosis due to unknown or not curable causes. Data of all consecutive patients with C-P class A cirrhosis attending the Liver Unit of the University Hospital of Messina from January 1st, 2004 to December 31st, 2010 were analyzed. Hypergammaglobulinemia is resulted the only and strong predictor of clinical outcomes, providing clear evidence that this biochemical data may help in identifying the C-P class A cirrhotics with poorer prognosis.