Patients with NASH cirrhosis have poorer prognosis than those with HBV

Patients with decompensated cirrhosis due to non-alcoholic steatohepatitis had worse outcomes and more complications than patients with hepatitis B virus, according to study results.

Hiang Keat Tan, MB, BS, MRCP, from the department of gastroenterology and hepatology at Singapore General Hospital, and colleagues wrote that they expect NASH to become a larger cause of cirrhosis in Asia and sought to determine its potential burden in the future by comparing outcomes with the current driver of liver disease in the region, HBV.

“Although potent antiviral drugs are now widely available for treatment of HBV, it still forms the bulk of patients needing liver transplantation in this region,” they wrote. “Therefore, it is imperative to study the trajectory in the natural history of decompensated NASH cirrhosis and compare it with HBV to understand the impact of both diseases on patient outcomes and their burden on health care resources in this region.”

Researchers analyzed data from patients admitted to the hospital with NASH or HBV cirrhosis for first-onset ascites from 2004 to 2015. They followed patients until death, liver transplantation or loss to follow-up.

Investigators found that patients with NASH had a lower median Model for End-Stage Liver Disease score than patients with HBV (11 [interquartile range 9-14] vs. 14 [11-17], P < .001). Patients with NASH cirrhosis also had higher cumulative incidence of dilutional hyponatremia and refractory ascites over 60 months of follow-up.

Tan and colleagues also found that patients with NASH had higher cumulative incidence of cirrhosis-related death and liver transplantation (65.7%; 95% CI, 53.6-75.4) compared with patients with HBV (42.5%; 95% CI, 32.4-55.2).

Additionally, in their analysis, researchers identified several predictors for poor transplant-free survival, including NASH, non-Chinese ethnicity and history of hepatocellular carcinoma.

“With the increase of NASH as an important cause of end-stage liver cirrhosis requiring liver transplantation globally, there is an urgent yet unmet need for a safe and efective treatment, especially in decompensated cirrhosis,” Tan and colleagues wrote. “The burden of NASH cirrhosis on the health care system is tremendous and is likely to continue unabated until a breakthrough is achieved in the search for the elusive drug treatment.”