Survival, liver failure, and hepatocellular carcinoma in obesity-related cryptogenic cirrhosis.
Despite the rising incidence of obesity and diabetes, there is little emphasis on morbidity and mortality from obesity-related cirrhosis, usually considered a rare and asymptomatic condition. Our aim was to assess survival and the occurrence of hepatocellular carcinoma and complications of hepatic insufficiency in obesity-related cryptogenic cirrhosis compared with cirrhosis of other origins. We analyzed retrospectively 27 overweight patients with cryptogenic cirrhosis (CC-O), 10 lean patients with cryptogenic cirrhosis (CC-L) and 391 patients with hepatitis C virus-related cirrhosis (C-HCV). In CC-O patients, cirrhosis was detected later in life than in C-HCV and CC-L patients. Severe liver disease was as frequent in CC-O as in C-HCV patients as indicated by the proportion of Child B or C or of episodes of hepatic decompensation. Survival of CC-O patients was lower than that of untreated, age- and sex-matched C-HCV controls (P <.02 at 30 months), with a higher mortality of Child B or C patients. Hepatocellular carcinoma was detected in 8 of 27 (27%) CC-O patients versus 21% of matched C-HCV controls with a similar age cumulated incidence, suggesting a comparable carcinogenic potential. In conclusion, obesity-related cirrhosis should now be recognized as a distinct entity that can cause severe liver disease and death. Increased awareness of and better diagnostic strategies for nonalcoholic steatohepatitis in overweight patients are urgently needed.
Ratziu
Vlad
V
Service d'Hépatogastroenterologie, Hôpital Pitié Salpétrière, Paris, France. vratziu@teaser.fr
Bonyhay
Luminita
L
Di Martino
Vincent
V
Charlotte
Frederic
F
Cavallaro
Lucas
L
Sayegh-Tainturier
Marie-Hélène
MH
Giral
Philippe
P
Grimaldi
André
A
Opolon
Pierre
P
Poynard
Thierry
T
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology / Q000401:mortality*; D017093:Liver Failure / Q000209:etiology / Q000401:mortality*; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000401:mortality*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index