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. (HEPATOLOGY 2006;43:682-689.)

The diagnosis and management of non-alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association

“…[48][49][50][51][52][53] Several studies investigated the natural history of NASH cirrhosis in comparison to patients with hepatitis C cirrhosis. [54][55][56][57] One large prospective US-based study 55 observed a lower rate of decompensation and mortality in patients with NASH cirrhosis as compared to patients with hepatitis C cirrhosis. However, a more recent international study 56 of 247 NAFLD patients with advanced fibrosis and cirrhosis followed over a mean duration of 85.6 6 54.5 months showed an overall 10-year survival of 81.5% that was not different from matched patients with hepatitis C cirrhosis.…”

“…Importantly, both studies have shown that patients with NASH cirrhosis are at significantly lower risk for HCC than patients with hepatitis C cirrhosis. 55,56 Alcohol Consumption & Definition of NAFLD By definition, NAFLD indicates the lack of any evidence of ongoing or recent consumption of significant quantities of alcohol. However, the precise definition of significant alcohol consumption in patients with suspected NAFLD is uncertain.…”

The NAFLD fibrosis score: A noninvasive system that identifies liver fibrosis in patients with NAFLD

“…4 The clinical implications of this alarming prevalence of NAFLD are derived from the fact that NAFLD may progress to cirrhosis, liver failure, and HCC. [5][6][7][8] Within the spectrum of NAFLD, simple bland steatosis often remains stable for a number of years and will probably never progress in many patients. 9,10 A subset of patients, however, particularly those with more advanced fibrosis, are at a higher risk for progressing to decompensated cirrhosis, portal hypertension, HCC, or death if liver transplantation is not accomplished.…”

“…9,10 A subset of patients, however, particularly those with more advanced fibrosis, are at a higher risk for progressing to decompensated cirrhosis, portal hypertension, HCC, or death if liver transplantation is not accomplished. [5][6][7][8][11][12][13][14] In contrast to patients with bland steatosis, patients with increased liver fibrosis require close follow-up with surveillance for the development of esophageal varices and HCC and enrollment into treatment trials. Thus, identifying the presence and severity of liver fibrosis in patients with NAFLD is of major importance in guiding the subsequent management of patients with this liver condition.…”

The importance of fatty liver disease in clinical practice

“…However, in a systematic review of paired biopsy studies only the presence of inflammation of any grade and increased age were independent risk factors for fibrosis progression. In another study, patients with cirrhosis due to NAFLD were compared to a group of patients with cirrhosis due to the hepatitis C virus (36) . Patients from both groups were most likely to die from complications of sepsis.…”