Saturday, October 28, 2017

Alcoholic liver disease confers a worse prognosis than HCV and non-alcoholic fatty liver disease among patients with cirrhosis

Alcoholic liver disease confers a worse prognosis than HCV infection and non-alcoholic fatty liver disease among patients with cirrhosis: An observational study
Astrid Marot, Jean Henrion, Jean-Fran├žois Knebel, Christophe Moreno, Pierre Deltenre
Published: October 27, 2017 https://doi.org/10.1371/journal.pone.0186715

In conclusion, patients with cirrhosis related to alcoholic liver disease (ALD) have a lower incidence of HCC but die more frequently from decompensation of cirrhosis than patients with cirrhosis related to chronic HCV infection or non-alcoholic fatty liver disease (NAFLD). Cirrhosis related to ALD should be considered as a condition associated with a poor outcome. This population should deserve specific patient care focused on the management of complications related to liver failure. The impact of HCC surveillance on mortality remains to be established in ALD patients.

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Abstract
Background
Cirrhosis 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.

Aim
To assess the impact of the underlying liver disease on the occurrence of hepatocellular carcinoma (HCC) and death.

Methods
Data 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).

Results
At 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.

Conclusion
Despite a lower incidence of HCC, patients with ALD-related cirrhosis have a worse outcome than those with chronic HCV infection or NAFLD-related cirrhosis.

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