Abstract
BackgroundCirrhosis is a heterogeneous clinical condition that includes patients at wide-ranging stages of severity. The role of the underlying liver disease on patient prognosis remains unclear.AimTo assess the impact of the underlying liver disease on the occurrence of hepatocellular carcinoma (HCC) and death.MethodsData related to the occurrence of HCC and death were collected during a 21-year period among patients with cirrhosis related to alcoholic liver disease (ALD) (n = 529), chronic hepatitis C virus (HCV) infection (n = 145) or non-alcoholic fatty liver disease (NAFLD) (n = 78).ResultsAt inclusion, ALD patients were younger than HCV and NAFLD patients (56 vs. 67 vs. 63 years; p<0.001) and had worse liver function (percent of patients with Child-Pugh stages B or C: 48% vs. 8% vs. 17%; p<0.001). During follow-up, 85 patients developed HCC and 379 died. The 10-year cumulative incidence rate of HCC was lower in ALD patients than in HCV and NAFLD patients (8.4% vs. 22.0% vs. 23.7%; p<0.001). The 10-year cumulative incidence rates of mortality were not statistically different between ALD, HCV and NAFLD patients (58.1% vs. 47.7% vs. 49.9%; p = 0.078). Alcohol abstinence and viral eradication were associated with reduced mortality among ALD and HCV patients, respectively. In multivariate analyses, ALD was associated with a reduced risk of HCC (0.39; 95% CI, 0.20–0.76; p = 0.005) but with a higher risk of mortality (1.53; 95% CI, 1.20–1.95; p<0.001). ALD patients died more frequently from decompensation of cirrhosis.ConclusionDespite a lower incidence of HCC, patients with ALD-related cirrhosis have a worse outcome than those with chronic HCV infection or NAFLD-related cirrhosis.
Highlights
Cirrhosis is associated with high mortality rates, and is the main indication for liver transplantation
The 10-year cumulative incidence rate of hepatocellular carcinoma (HCC) was lower in alcoholic liver disease (ALD) patients than in hepatitis C virus (HCV) and nonalcoholic fatty liver disease (NAFLD) patients (8.4% vs. 22.0% vs. 23.7%; p
Alcohol abstinence and viral eradication were associated with reduced mortality among ALD and HCV patients, respectively
Summary
Cirrhosis is associated with high mortality rates, and is the main indication for liver transplantation. It is a heterogeneous clinical condition that includes patients with different causes of chronic liver disease and at wide-ranging stages of severity. A poor survival has been reported among cirrhotic patients with ALD compared to those with HCV infection [1] while other studies have indicated that the cause of liver disease does not affect prognosis [2,3,4,5]. The prognosis of patients with ALD-related cirrhosis remains poorly defined and further studies assessing whether ALD confers a different prognosis among patients with cirrhosis than chronic HCV infection or NAFLD are essential to improve patient care. Cirrhosis is a heterogeneous clinical condition that includes patients at wide-ranging stages of severity. Editor: Pavel Strnad, Medizinische Fakultat der RWTH Aachen, GERMANY Received: July 6, 2017 Accepted: October 8, 2017
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