Similarities and differences in outcomes of cirrhosis due to nonalcoholic steatohepatitis and hepatitis C.
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.
Sanyal
Arun J
AJ
Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, VA 23298-0341, USA. ajsanyal@hsc.vcu.edu
Banas
Colin
C
Sargeant
Carol
C
Luketic
Velimir A
VA
Sterling
Richard K
RK
Stravitz
Richard T
RT
Shiffman
Mitchell L
ML
Heuman
Douglas
D
Coterrell
Adrian
A
Fisher
Robert A
RA
Contos
Melissa J
MJ
Mills
Alan S
AS
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