Differences in complications between hepatitis B-related cirrhosis and alcohol-related cirrhosis.

Yu-Pei Zhuang,Si-Qi Wang,Hao-Jie Zhong,Xing-Xiang He,Zhao-Yu Pan

doi:10.1515/med-2021-0401

Abstract

ObjectivesThis study aimed to investigate the differences in complications between hepatitis B virus (HBV)-related and alcohol-related cirrhoses.MethodsMedical records of patients with HBV-related and alcohol-related cirrhoses treated from January 2014 to January 2021 were, retrospectively, reviewed. The unadjusted rate and adjusted risk of cirrhotic complications between the two groups were assessed.ResultsThe rates of hepatocellular carcinoma (HCC) and hypersplenism were higher in HBV-related cirrhosis (both P < 0.05), whereas the rates of hepatic encephalopathy (HE) and acute-on-chronic liver failure (ACLF) were higher in alcohol-related cirrhosis (both P < 0.05). After adjusting for potential confounders, HBV-related cirrhotic patients had higher risks of HCC (odds ratio [OR] = 34.06, 95% confidence interval [CI]: 4.61–251.77, P = 0.001) and hypersplenism (OR = 2.29, 95% CI: 1.18–4.42, P = 0.014), whereas alcohol-related cirrhotic patients had higher risks of HE (OR = 0.22, 95% CI: 0.06–0.73, P = 0.013) and ACLF (OR = 0.30, 95% CI: 0.14–0.73, P = 0.020).ConclusionCirrhotic patients with different etiologies had different types of complications: HBV-related cirrhotic patients exhibited increased risks of HCC and hypersplenism and alcohol-related cirrhotic patients more readily developing HE and ACLF.

Highlights

Cirrhosis, as an advanced stage of chronic liver disease, and its complications are associated with high morbidity and cause more than 1 million deaths worldwide annually [1]
Patient medical data were extracted from the hospital information system as follows: demographics, alcoholism, smoking status, medical history, clinical presentation, imaging results, and laboratory results including alanine transaminase (ALT), aspartate transaminase (AST), bilirubin, serum albumin, lipid profile, international normalized ratio (INR), prothrombin time (PT), routine examination of blood, and serum ammonia
The cirrhosis diagnosis was based on pathological findings or a combination of clinical presentation and imaging and

Summary

Introduction

As an advanced stage of chronic liver disease, and its complications are associated with high morbidity and cause more than 1 million deaths worldwide annually [1]. In 2015, nearly 240 million people globally had HBV infection, and there were approximately 0.45 million deaths due to HBV-related cirrhosis and its complications [2]. In 2010, nearly 0.5 million deaths worldwide were caused by alcohol-related cirrhosis, which accounted for approximately 50% of all cirrhosisrelated deaths [4]. Cirrhotic patients with severe hepatic encephalopathy (HE) had a first-year mortality rate of more than 50% [7,8]. Cirrhotic patients with acute-on-chronic liver failure (ACLF) had a high 28 day mortality rate caused by acute decompensation, organ failure, and/or serious systemic inflammation [9]. Hepatocellular carcinoma (HCC), as a major cause of cancer-associated death, has a very poor prognosis and a 5 year survival rate of less than 15% [10]

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