title: Similarities and differences in outcomes of cirrhosis due to nonalcoholic steatohepatitis and hepatitis C.
abstract: The objective of this study was to prospectively define outcomes of cirrhosis due to nonalcoholic steatohepatitis (NASH) and compare them with those associated with hepatitis C virus (HCV) infection. We compared 152 patients with cirrhosis due to NASH with 150 matched patients with cirrhosis due to HCV. Over 10 years, 29/152 patients with cirrhosis due to NASH died compared with 44/150 patients with HCV (P < .04). This was mainly due to the lower mortality rate in patients with Child class A cirrhosis due to NASH versus HCV (3/74 vs. 15/75; P < .004). There were no significant across-group differences in mortality in patients with Child class B or C cirrhosis. Sepsis was the most common cause of death in both groups; patients with NASH had a higher cardiac mortality (8/152 vs. 1/150; P < .03). Patients with Child class A cirrhosis due to NASH also had a significantly lower risk of decompensation, defined by a 2-point increase in Child-Turcotte-Pugh score (P < .007). Cirrhosis due to NASH was associated with a lower rate of development of ascites (14/101 vs. 40/97 patients at risk; P < .006). NASH also had a significantly lower risk of development of hepatocellular carcinoma (10/149 vs. 25/147 patients at risk; P < .01). In conclusion, compensated cirrhosis due to NASH is associated with a lower mortality rate compared with that due to HCV. It is also associated with a lower rate of development of ascites, hyperbilirubinemia, and hepatocellular carcinoma. However, cardiovascular mortality is greater in patients with NASH.
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, VA 23298-0341, USA. ajsanyal@hsc.vcu.edu
authors.forename: Arun J
authors.initials: AJ
authors.lastname: Sanyal
authors.forename: Colin
authors.initials: C
authors.lastname: Banas
authors.forename: Carol
authors.initials: C
authors.lastname: Sargeant
authors.forename: Velimir A
authors.initials: VA
authors.lastname: Luketic
authors.forename: Richard K
authors.initials: RK
authors.lastname: Sterling
authors.forename: Richard T
authors.initials: RT
authors.lastname: Stravitz
authors.forename: Mitchell L
authors.initials: ML
authors.lastname: Shiffman
authors.forename: Douglas
authors.initials: D
authors.lastname: Heuman
authors.forename: Adrian
authors.initials: A
authors.lastname: Coterrell
authors.forename: Robert A
authors.initials: RA
authors.lastname: Fisher
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Contos
authors.forename: Alan S
authors.initials: AS
authors.lastname: Mills
mesh_terms: D001201:Ascites / Q000209:etiology; D006528:Carcinoma, Hepatocellular / Q000209:etiology; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D015331:Cohort Studies; D018450:Disease Progression; D004932:Esophageal and Gastric Varices / Q000209:etiology; D005234:Fatty Liver / Q000150:complications*; D005260:Female; D006501:Hepatic Encephalopathy / Q000209:etiology; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D006932:Hyperbilirubinemia / Q000209:etiology; D008103:Liver Cirrhosis / Q000150:complications* / Q000209:etiology / Q000401:mortality*; D017093:Liver Failure / Q000209:etiology; D008113:Liver Neoplasms / Q000209:etiology; D008297:Male; D008875:Middle Aged