Similarities and differences in outcomes of cirrhosis due to nonalcoholic steatohepatitis and hepatitis C

Authors

  • Arun J. Sanyal,

    Corresponding author
    1. Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, VA
    • Professor of Medicine, Pharmacology, and Pathology, Virginia Commonwealth University Medical Center, MCV Box 980341, Richmond, VA 23298-0341
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    • fax: 804-828-2037

  • Colin Banas,

    1. Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, VA
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  • Carol Sargeant,

    1. Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, VA
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  • Velimir A. Luketic,

    1. Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, VA
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  • Richard K. Sterling,

    1. Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, VA
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  • Richard T. Stravitz,

    1. Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, VA
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  • Mitchell L. Shiffman,

    1. Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, VA
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  • Douglas Heuman,

    1. Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, VA
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  • Adrian Coterrell,

    1. Division of Transplant Surgery, Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, VA
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  • Robert A. Fisher,

    1. Division of Transplant Surgery, Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, VA
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  • Melissa J. Contos,

    1. Department of Pathology, Virginia Commonwealth University Medical Center, Richmond, VA
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  • Alan S. Mills

    1. Department of Pathology, Virginia Commonwealth University Medical Center, Richmond, VA
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  • Potential conflict of interest: Nothing to report.

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.)

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