Comparison of outcomes between patients with alcoholic cirrhosis and those with hepatitis C virus-related cirrhosis.
OBJECTIVE
The natural history of alcoholic cirrhosis, especially in Asian countries, has not been completely understood thus far.


METHODS
We retrospectively compared the outcomes of compensated cirrhosis between Japanese alcoholic and hepatitis C virus (HCV)-infected patients.


RESULTS
A total of 227 patients (75 alcoholic and 152 HCV-infected patients) with compensated cirrhosis were enrolled. The median follow-up period was 4.9 years. The cumulative rates of hepatocellular carcinoma (HCC) development were significantly lower in the alcoholic patients than in the HCV-infected patients (6.8% vs 50.3% at 10 years, P = 0.0003), while the cumulative rates of hepatic decompensation (37.4% vs 51.7% at 10 years) and survival (53.8% vs 47.4% at 10 years) did not significantly differ between the two groups (Kaplan-Meir analysis). The main causes of death were hepatic failure and non-hepatic diseases in the alcoholic patients and HCC and hepatic failure in the HCV-infected patients. Multivariate analyses using the Cox proportional hazard model revealed that the risk of HCC was lower in alcoholic cirrhosis than in HCV-related cirrhosis (hazard ratio (HR), 0.46), while the risk of hepatic decompensation and mortality was the same. Predictors of decreased survival were non-abstinence (HR, 2.53) in the alcoholic patients and low serum albumin level (1.58) in the HCV-infected patients.


CONCLUSIONS
Survival of patients with alcoholic cirrhosis was similar to that of patients with HCV-related cirrhosis. The risk of HCC development was lower in alcoholic cirrhosis than in HCV-related cirrhosis. Abstinence from alcohol was important for improving the survival of patients with alcoholic cirrhosis.
Toshikuni
Nobuyuki
N
Department of Internal Medicine, Center for Liver Diseases, Kawasaki Hospital, Kawasaki Medical School, Okayama, Japan. n.toshikuni@gmail.com
Izumi
Akiyoshi
A
Nishino
Ken
K
Inada
Nobu
N
Sakanoue
Ritsuko
R
Yamato
Ryumei
R
Suehiro
Mitsuhiko
M
Kawanaka
Miwa
M
Yamada
Gotaro
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People / Q000706:statistics & numerical data; D006528:Carcinoma, Hepatocellular / Q000209:etiology* / Q000401:mortality / Q000821:virology; D002423:Cause of Death; D018450:Disease Progression; D005260:Female; D006526:Hepatitis C / Q000150:complications* / Q000208:ethnology / Q000401:mortality; D006801:Humans; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications / Q000208:ethnology / Q000401:mortality / Q000821:virology*; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications* / Q000208:ethnology / Q000401:mortality; D017093:Liver Failure / Q000209:etiology* / Q000401:mortality / Q000821:virology; D008113:Liver Neoplasms / Q000209:etiology* / Q000401:mortality / Q000821:virology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013695:Temperance; D013997:Time Factors