The Prognosis and Risk Factors for Hepatocellular Carcinoma in Nonalcoholic Steatohepatitis Related Cirrhosis: An Ambispective Cohort Study

Abstract

Background: Nonalcoholic fatty liver disease is one of the major public health diseases wordwide. Our aim was to investigate the prognosis,clinical features and risk factors associated with development to hepatocellular carcinoma (HCC) in patients with nonalcoholic steatohepatitis (NASH) related cirrhosis. Methods: From January 2010 to December 2013, a total of 5249 cirrhotic patients hospitalized firstly in Beijing You'an hospital in an ambispective cohort were evaluated. Of which 160 cases were diagnosed as NASH-related cirrhosis. With three years of follow-up, 81patients in the group with NASH-related cirrhosis and 254 patients in the control group with hepatitis B cirrhosis, hepatitis C cirrhosis or alcoholic cirrhosis were analyzed. The primary endpoint was death. Second endpoints included hepatic encephalopathy(HE), hepatorenal syndrome(HRS), liver failure, ascites, esophagogastric variceal bleeding(EVB) and HCC. Results: In this cohort, NASH-related cirrhosis accounted for 3.0%(160/5249). A larger proportion of patients were women in NASH group than in control group (44.4%: 36/81 vs 26.8%: 68/254, P 0.05). Logistic regression analysis showed that elevated BMI and triglyceride levels were risk factors for the progression to HCC in patients with NASH related cirrhosis (P<0.05). Conclusions: Women with better prognosis were more common in NASH-related cirrhosis. Elevated BMI and triglyceride levels were risk factors associated with development HCC in NASH-related cirrhosis. Funding Statement: This study was supported by the State Key Projects Specialized on Infectious Diseases (NO. 2017ZX10203202-004, 2017ZX10201201-008,2017ZX10203202003008), Beijing Natural Science Foundation-Beijing Municipal Committee of Education (No. KZ201810025037), Beijing Municipal Administration of Hospitals Clinical Medicine Development of special funding (No. ZYLX201610), The Digestive Medical Coordinated Development Center of Beijing Municipal Administration of Hospitals(XXZ0303), Beijing high-level health technicians (No.2013-03-073) and Beijing Municipal Administration of Hospitals’Ascent Plan (No. DFL20151602). The funder had no roles in study design, data collection, data analysis and interpretation, or writing the manuscript. Declaration of Interests: All authors declare no conflict of interest. In addition, they have substantially contributed to this current study and approved the content of the manuscript. Ethics Approval Statement: This study was in accord with the declaration of Helsinki and was approved by the Ethics Committee of Beijing You’an Hospital, Capital Medical University (No.2018/029) and each participant gave written informed consent.