Poor Outcomes of Cirrhosis due to Nonalcoholic Steatohepatitis Compared With Hepatitis B After Decompensation With Ascites.
Aged
Ascites
/ etiology
Carcinoma, Hepatocellular
/ epidemiology
Case-Control Studies
End Stage Liver Disease
Ethnicity
/ statistics & numerical data
Female
Glomerular Filtration Rate
Hepatitis B, Chronic
/ complications
Humans
Liver Cirrhosis
/ etiology
Liver Neoplasms
/ epidemiology
Liver Transplantation
/ statistics & numerical data
Male
Middle Aged
Multivariate Analysis
Non-alcoholic Fatty Liver Disease
/ complications
Prognosis
Proportional Hazards Models
Retrospective Studies
Risk Factors
Severity of Illness Index
Journal
The American journal of gastroenterology
ISSN: 1572-0241
Titre abrégé: Am J Gastroenterol
Pays: United States
ID NLM: 0421030
Informations de publication
Date de publication:
01 07 2021
01 07 2021
Historique:
received:
18
09
2020
accepted:
05
01
2021
pubmed:
10
4
2021
medline:
31
8
2021
entrez:
9
4
2021
Statut:
ppublish
Résumé
Decompensation with ascites portends a poor prognosis in cirrhosis. The aim of this study was to compare the outcomes of patients with nonalcoholic steatohepatitis (NASH) with hepatitis B virus (HBV) cirrhosis after decompensation with ascites. We conducted a retrospective study to evaluate the outcomes of patients with NASH and HBV cirrhosis who were admitted to hospital for first-onset ascites from January 1, 2004, to June 30, 2015. They were followed up until death, liver transplantation, or loss to follow up. Patients with NASH had lower median (interquartile range) Model for End-Stage Liver Disease score (11 [9-14] vs 14 [11-17], P < 0.001). Over 60 months, patients with NASH cirrhosis had higher cumulative incidence of dilutional hyponatremia (P < 0.001) and refractory ascites (P = 0.028). They also had higher cumulative incidence of cirrhosis-related deaths and liver transplantation compared with HBV cirrhosis (65.7%; [95% confidence interval (CI) 53.6-75.4] vs 42.5% [95% CI 32.4-55.2], P = 0.008). Multivariable competing risk analysis showed that NASH (subdistribution hazard ratio [sHR] 1.88 [95% CI 1.14-3.11], P = 0.014), non-Chinese ethnicity (sHR 1.63 [95% CI 1.06-2.50], P = 0.027), history of hepatocellular carcinoma (sHR 1.76 [95% CI 1.05-2.95], P = 0.033), estimated glomerular filtration rate <60 mL/min/1.73 m2 (sHR 1.70 [95% CI 1.09-2.65], P = 0.020), and Model for End-Stage Liver Disease score ≥15 (sHR 3.26 [95% CI 2.11-5.05], P < 0.001) were independent predictors of poor transplant-free survival. Patients with decompensated cirrhosis due to NASH had much poorer prognosis compared with HBV with more complications and greater healthcare resource utilization. Greater awareness is necessary for early diagnosis of NASH before decompensation.
Identifiants
pubmed: 33834737
pii: 00000434-202107000-00018
doi: 10.14309/ajg.0000000000001176
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1437-1446Informations de copyright
Copyright © 2021 by The American College of Gastroenterology.
Références
Wong MCS, Huang JLW, George J, et al. The changing epidemiology of liver diseases in the Asia-Pacific Region. Nat Rev Gastroenterol Hepatol 2019;16:57–73.
Saunders JB, Walters JR, Davis AP, et al. A 20-year prospective study of cirrhosis. Br Med J (Clin Res Ed) 1981;282:263–6.
Kodali VP, Gordon SC, Silverman AL, et al. Cryptogenic liver disease in the United States: Further evidence of non-A, non-B and non-C hepatitis. Am J Gastroenterol 1994;89:1836–9.
Maheshwari A, Thuluvath PJ. Cryptogenic cirrhosis and NAFLD: Are they related? Am J Gastroenterol 2006;101:664–8.
Caldwell SH, Oelsner DH, Iezzoni JC, et al. Cryptogenic cirrhosis: Clinical characterization and risk factors for underlying disease. Hepatology 1999;29:664–9.
Ginés P, Arroyo V, Téres J, et al. Compensated cirrhosis: Natural history and prognostic factors. Hepatology 1987;7:122–8.
Planas R, Ballesté B, Álvarez A, et al. Natural history of decompensated hepatitis C virus-related cirrhosis. A study of 200 patients. J Hepatol 2004;40:823–30.
Bruno S, Saibeni S, Bagnardi V, et al. Mortality risk according to different clinical characteristics of first ever episode of liver decompensation in cirrhotic patients: A nationwide, prospective, 3-year follow-up study in Italy. Am J Gastroenterol 2013;108:1112–22.
Kim SU, Han KH, Nam CM, et al. Natural history of hepatitis B virus-related cirrhotic patients hospitalized to control ascites. J Gastroenterol Hepatol 2008;23:1722–7.
Das K, Das K, Datta S, et al. Course of disease and survival after onset of decompensation in hepatitis B virus-related cirrhosis. Liver Int 2010;30:1033–42.
Jang JW, Choi JY, Kim YS, et al. Long-term effect of antiviral therapy on disease course after decompensation in patients with hepatitis B virus-related cirrhosis. Hepatology 2015;61:1809–20.
Hui JM, Kench JG, Chitturi S, et al. Long-term outcomes of cirrhosis in non-alcoholic steatohepatitis compared with hepatitis C. Hepatology 2003;38:420–7.
Sanyal AJ, Banas C, Sargeant C, et al. Similarities and differences in outcomes of cirrhosis due to non-alcoholic steatohepatitis and hepatitis C. Hepatology 2006;43:682–9.
Bhala N, Angulo P, Poorten DVD, et al. The natural history of nonalcoholic fatty liver disease with advanced fibrosis or cirrhosis: An international collaborative study. Hepatology 2011;54:1208–16.
Alberti KGMM, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: A joint interim statement of the International Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and the International Association for the Study of Obesity. Circulation 2009;120:1640–5.
Yao YF, Ferrel L, Bass NM, et al. Liver transplantation for hepatocellular carcinoma: Expansion of the tumor size limits does not adversely impact survival. Hepatology 2001;33:1394–403.
Moreau R, Jalan R, Gines P, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology 2013;144:1426–37.
Francoz C, Nadim MK, Baron A, et al. Glomerular filtration rate equations for liver-kidney transplantation in patients with cirrhosis: Validation of current recommendations. Hepatology 2014;59:1514–21.
Salerno F, Guevara M, Bernardi M, et al. Refractory ascites: Pathogenesis, definition and therapy of a severe complication in patients with liver cirrhosis. Liver Int 2010;30:937–47.
Angeli P, Ginés P, Wong F, et al. Diagnosis and management of acute kidney injury in patients with cirrhosis: Revised consensus recommendations of the international ascites Club. J Hepatol 2015;62:968–74.
Fontana RJ, Hann HW, Perrillo RP, et al. Determinants of early mortality in patients with decompensated chronic hepatitis B treated with antiviral therapy. Gastroenterology 2002;123:719–27.
Kanda Y. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant 2013;48:452–8.
Jang JW, Choi JY, Kim YS, et al. Effects of virologic response to treatment on short- and long-term outcomes of patients with chronic hepatitis B virus infection and decompensated cirrhosis. Clin Gastroenterol Hepatol 2018;16:1954–63.
Lim RBT, Zheng H, Yang Q, et al. Ethnic and gender specific life expectancies of the Singapore population, 1965 to 2009 - converging, or diverging? BMC Public Health 2013;13:1102.
Planas R, Montoliu S, Ballesté B, et al. Natural history of patients hospitalized for management of cirrhotic ascites. Clin Gastroenterol Hepatol 2006;4:1385–94.
Yu SM, Bonvenre JV. Acute kidney injury and progression of diabetic kidney disease. Adv Chronic Kidney Dis 2018;25:166–80.
Wong F, Reddy KR, O'Leary JG, et al. Impact of chronic kidney disease on outcomes in cirrhosis. Liver Transpl 2019;25:870–80.
García-Pagán JC, Gracia-Sancho J, Bosch J. Functional aspects on the pathophysiology of portal hypertension in cirrhosis. J Hepatol 2012;57:458–61.
Manolakopoulos S, Triantos C, Theodoropoulos J, et al. Antiviral therapy reduces portal pressure in patients with cirrhosis due to HBeAg-neagative chronic hepatitis B and significant portal hypertension. J Hepatol 2009;51:468–74.
Kim SS, Hwang JC, Lim SG, et al. Effect of virological response to entecavir on the development of hepatocellular carcinoma in hepatitis B viral cirrhotic patients: Comparison between compensated and decompensated cirrhosis. Am J Gastroenterol 2014;109:1223–33.
Yang JD, Abdelmalek MF, Pang H, et al. Gender and menopause impact severity of fibrosis among patients with nonalcoholic steatohepatitis. Hepatology 2014;59:1406–14.
Yang JD, Abdelmalek MF, Guy CD, et al. Patient sex, reproductive status, and synthetic hormone use associated with histologic severity of nonalcoholic steatohepatitis. Clin Gastroenterol Hepatol 2017;15:127–31.
( https://www.singstat.gov.sg/-/media/files/publications/population/population2019.pdf ). Accessed May 29, 2020.
Zain SM, Mohamed R, Mahadeva S, et al. A multi-ethnic study of a PNPLA3 gene variant and its association with disease severity in non-alcoholic fatty liver disease. Hum Genet 2012;131:1145–52.
Singh S, Allen AM, Wang Z, et al. Fibrosis progression in nonalcoholic fatty liver vs nonalcoholic steatohepatitis: A systematic review and meta-analysis of paired-biopsy studies. Clin Gastroeterol Hepatol 2015;13:643–54.
Goh GBB, Kwan C, Lim SY, et al. Perceptions of non-alcoholic fatty liver disease—An Asian community-based study. Gastroenterol Rep (Oxf) 2016;4:131–5.
Ratziu V, Cadrenal JF, Serfaty L, et al. A survey of patterns of practice and perception of NAFLD in a large sample of practicing gastroenterologists in France. J Hepatol 2012;57:376–83.
Nourreddin M, Chan JL, Barradas K, et al. Attribution of nonalcoholic steatohepatitis as an etiology of cirrhosis for clinical trials eligibility: Recommendations from the multi-stakeholder Liver Forum. Gastroenterology 2020;159:422–7.