Abstract
In alcoholic liver cirrhosis (LC) patients, obesity has become a problem that progresses into liver dysfunction. Herein, we investigated the relationship between the prognosis of steatohepatitis and body weight, along with fat accumulation in patients with alcoholic LC. We conducted a single-center retrospective study, enrolled 104 alcoholic LC patients without hepatocellular carcinoma (HCC) based on histological and clinical evidence, and investigated factors related to poor prognosis using multivariate Cox regression and cluster analyses. Cox regression analysis revealed three independent relevant factors: subcutaneous adipose tissue (SAT) index (median 34.8 cm2/m2, P = 0.009, hazard ratio [HR] 1.017, 95% confidence interval [CI] 1.004–1.030), total bilirubin level (median 1.7 mg/dL, P = 0.003, HR 1.129, 95% CI 1.042–1.223), and prothrombin time value (median 64%, P = 0.007, HR 0.967, 95% CI 0.943–0.991). In the cluster analysis, we categorized the patients into three groups: no adipose tissue accumulation (NAT group), SAT prior accumulation (SAT group), and visceral adipose tissue prior accumulation (VAT group). The results of the three groups revealed that the SAT group displayed a significantly poor prognosis of the Kaplan–Meier curve (67.1 vs 21.2 vs 65.3, P<0.001) of a 5-year survival rate. Propensity score matching analysis of the SAT and VAT groups was performed to adjust the patient’s background, but no significant differences were found between them; however, the prognosis was poorer (21.2 vs 66.3, P<0.001), and hemostatic factors were still at a lower level in the SAT group. These findings suggest that SAT accumulation type of obesity is a poor prognostic factor in alcoholic LC patients without HCC, and the hemorrhagic tendency might worsen the poor prognosis in such cases.
Highlights
Because of the development of antiviral agents with negligible adverse effects switched from interferon therapies, liver diseases caused by the hepatitis C virus have decreased gradually and undoubtedly [1]
body mass index (BMI) correlated with the adipose tissue area: subcutaneous adipose tissue (SAT) index, visceral adipose tissue (VAT) index, and total adipose tissue (TAT) index. 45 cm2/m2 of the SAT and VAT indexes and 90 cm2/m2 of the TAT index were equivalent to 25 kg/m2 of BMI, and 55 cm2/m2 of the TAT index was equivalent to 20 kg/m2 of BMI in the correlation analysis (Fig 1a)
We investigated the relevant factors for prognosis in 104 patients with alcoholic liver cirrhosis (LC) by univariate Cox regression analysis (Table 1) and found nine, as follows: BMI, SAT index, aspartate aminotransferase, alanine aminotransferase, albumin, total bilirubin, prothrombin time, fibrinogen and platelet count
Summary
Because of the development of antiviral agents with negligible adverse effects switched from interferon therapies, liver diseases caused by the hepatitis C virus have decreased gradually and undoubtedly [1]. Steatohepatitis caused by alcoholic and nonalcoholic has become a significant issue of concern even with the decrease in the commonly known viral. Obesity and SAT accumulation are poor prognostic factors in alcoholic LC hepatitis as the causal agent [2]. The distinction between alcoholic and nonalcoholic liver diseases is often difficult, owing to the unreliability of alcohol consumption history [4]. When chronic inflammation and fibrosis of the liver were induced by nutritional disorder, oxidative stress, inflammatory cytokines, adipocytokines, and dysbiosis were observed in both alcoholic and nonalcoholic steatohepatitis [5, 6]. In the pathogenic mechanisms of alcoholic liver injury, the biological metabolic changes and acetaldehyde metabolized by alcohol-induced injury [5], in particular, by dysbiosis and endotoxin via direct injury of gut mucosa by the alcohol, and are notable factors of liver damage [7]
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