Cirrhosis due to NASH tied to worse outcomes relative to HBV

Prognosis is much poorer in patients with decompensated cirrhosis due to nonalcoholic steatohepatitis (NASH) than in those with hepatitis B virus (HBV), with the former experiencing more complications and utilizing more healthcare resources, reveals a study.

This retrospective study sought to examine the outcomes of patients with NASH and HBV cirrhosis who were admitted to the hospital for first-onset ascites from 1 January 2004 to 30 June 2015. Patients were followed up until death, liver transplantation, or loss to follow-up.

NASH patients had lower median Model for End-Stage Liver Disease (MELD) score (11 vs 14; p<0.001). Over 60 months, patients with NASH cirrhosis showed higher cumulative incidence of dilutional hyponatraemia (p<0.001) and refractory ascites (p=0.028), as well as greater cumulated incidence of cirrhosis-related deaths and liver transplantation than those with HBV cirrhosis (65.7 percent, 95 percent confidence interval [CI], 53.6–75.4 vs 42.5 percent, 95 percent CI, 32.4–55.2; p=0.008).

In multivariable competing risk analysis, poor transplant-free survival was independently predicted by NASH (subdistribution hazard ratio [SHR], 1.88, 95 percent CI, 1.14–3.11; p=0.014), non-Chinese ethnicity (SHR, 1.63, 95 percent CI, 1.06–2.50; p=0.027), hepatocellular carcinoma history (SHR, 1.76, 95 percent CI, 1.05–2.95; p=0.033), estimated glomerular filtration rate <60 mL/min/1.73 m² (SHR, 1.70, 95 percent CI, 1.09–2.65; p=0.020), and MELD score ≥15 (SHR, 3.26, 95 percent CI, 2.11–5.05; p<0.001).

“Greater awareness is necessary for early diagnosis of NASH before decompensation,” the authors said.