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

Cirrhosis related to non-alcoholic steatohepatitis (NASH) is associated with fewer complications and a lower mortality compared to cirrhosis from hepatitis C, despite NASH patients' greater risk of dying from cardiovascular events. These findings are published in the April 2006 issue of Hepatology, the official journal of the American Association for the Study of Liver Diseases (AASLD).

Non-alcoholic steatohepatitis can develop as a consequence of obesity and the metabolic syndrome. It is considered a "silent" disease, with most sufferers feeling well, in spite of inflammation and damage to the liver. But NASH can progress to cirrhosis in up to 20 percent of cases. With obesity becoming more prevalent in the U.S., the health care burden related to cirrhosis due to NASH is expected to rise. Up to now, however, little has been known of the natural history of cirrhosis associated with NASH.

Researchers led by Arun J. Sanyal, M.D. of Virginia Commonwealth University Medical Center in Richmond, sought to prospectively define the clinical outcomes of cirrhosis due to NASH, and compare them to those associated with hepatitis C virus (HCV) infection. They studied 152 patients with cirrhosis due to NASH and matched them with 150 patients with cirrhosis due to HCV. For each participant, the researchers collected information on mortality and morbidity, including synthetic failure, varices and variceal hemorrhage, ascites, encephalopathy and hepatocellular cancer.

Over ten years, 29 of the 152 subjects with cirrhosis due to NASH died, compared to 44 of the 150 subjects with cirrhosis due to HCV. Sepsis was the most common cause of death in both groups and was often associated with acute or chronic liver failure.

At the same time, cardiac events killed many more patients with NASH (8 out of 152) than with HCV (1 out of 150) a finding that is "noteworthy, although not unexpected," report the authors. "This group has significantly higher prevalence of risk factors for coronary heart disease and congestive heart failure than those with HCV."

During the study, patients with cirrhosis due to NASH and normal liver functions developed fewer complications of cirrhosis: 14 NASH patients developed ascites, compared to 40 HCV patients. Also, fewer NASH patients than HCV patients developed encephalopathy and variceal hemorrhage, and significantly fewer developed liver cancer. However, once the liver functions declined below normal levels, the outcomes of patients with NASH were the same as those with cirrhosis from hepatitis C.

"These are the first prospective data on the relative risks of developing specific complications of cirrhosis in subjects with NASH," the authors report. NASH patients fared better overall compared to HCV patients, though many did develop complications of cirrhosis. Ascites was the most common complication contributing to mortality.

"These data are likely to be important in the design of future therapeutic interventions in this patient population," the authors conclude, "and also in the everyday management of such patients in clinical practice."