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Clinical features and natural history of cryptogenic cirrhosis compared to hepatitis C virus-related cirrhosis.
- Source :
-
World journal of gastroenterology [World J Gastroenterol] 2017 Feb 28; Vol. 23 (8), pp. 1458-1468. - Publication Year :
- 2017
-
Abstract
- Aim: To characterize natural history of cryptogenic cirrhosis (CC) and compare its clinical features and outcomes to those of hepatitis C virus (HCV)-related cirrhosis.<br />Methods: A prospective cohort of 102 consecutive patients at their first diagnosis of CC were enrolled in this study. The clinical data and outcomes were compared to an age- and Child-Pugh class-matched cohort of 110 patients with HCV-related cirrhosis. Diagnosis of cirrhosis was based on compatible clinical and laboratory parameters, ultrasound/endoscopic parameters and, whenever possible, on histological grounds and transient elastography. All cases of cirrhosis without a definite etiology were enrolled in the CC group. The parameters assessed were: (1) severity of liver disease at the time of first diagnosis; (2) liver decompensation during follow-up; (3) hepatocellular carcinoma (HCC); (4) orthotopic liver transplantation; and (5) death. The independent associated factors were evaluated by multiple logistic regression analysis, and survival and its determinants by the Kaplan-Meier model, log-rank test and Cox regression.<br />Results: At the first observation, median age was 66 and 65 years and male gender was 36% and 58% for CC and HCV cirrhosis, respectively. CC showed Child-Pugh class A/B/C of 47%/31%/22%, respectively. Compared to HCV cirrhosis, CC exhibited a significantly higher prevalence of metabolic syndrome (12% vs 54%, respectively), overweight/obesity, high BMI, impaired glucose tolerance, high blood pressure, dyslipidemia, hyperuricemia, cardiovascular diseases, extrahepatic cancer, and gallstones. Over a median period of 42 mo of follow-up, liver decompensation, HCC development and death for CC and HCV-related cirrhosis were 60.8%, and 54.4%, 16.7% and 17.2%, 39.2% and 30%, respectively. The median survival was 60 mo for CC. Independent predictors of death were age and Child-Pugh class at diagnosis. CC showed an approximately twofold higher incidence of HCC in Child-Pugh class A.<br />Conclusion: Undiagnosed nonalcoholic fatty liver disease has an etiologic role in CC that is associated with a poor prognosis, early HCC development, high risk of cardiovascular disease and extrahepatic cancer.<br />Competing Interests: Conflict-of-interest statement: There is no conflict of interest to report.
- Subjects :
- Adult
Aged
Aged, 80 and over
Carcinoma, Hepatocellular diagnosis
Female
Follow-Up Studies
Hepatitis C mortality
Humans
Kaplan-Meier Estimate
Liver Cirrhosis mortality
Liver Cirrhosis virology
Liver Failure complications
Liver Neoplasms diagnosis
Male
Middle Aged
Non-alcoholic Fatty Liver Disease complications
Proportional Hazards Models
Prospective Studies
Regression Analysis
Treatment Outcome
Hepatitis C diagnosis
Liver Cirrhosis congenital
Liver Cirrhosis diagnosis
Subjects
Details
- Language :
- English
- ISSN :
- 2219-2840
- Volume :
- 23
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- World journal of gastroenterology
- Publication Type :
- Academic Journal
- Accession number :
- 28293093
- Full Text :
- https://doi.org/10.3748/wjg.v23.i8.1458