Comparison of outcomes of patients with alcoholic cirrhosis and non-alcoholic steatohepatitis (NASH) related cirrhosis

Abstract

OBJECTIVES: Most cases of cirrhosis in Sri Lanka are alcohol induced or cryptogenic. There is mounting evidence that a high proportion of cryptogenic cirrhosis is NASFI related. Although longterm outcome of NASH-cirrhosis is similar to Hepatitis C-cirrhosis, there has been no comparison with outcome of alcoholic cirrhosis. This study was done to compare long term outcomes of probable NASH-cirrhosis and alcoholic cirrhosis. METHODS: Patients with alcoholic cirrhosis and probable NASH-cirrhosis (cryptogenic cirrhosis with type-2 diabetes mellitus or obesity) whose clinical and follow-up details were available were identified from our cirrhosis database. Patients or their families were contacted to obtain the survival status and the date of death. The cause of death was obtained from death certificates and patient records. Outcomes of the two groups were compared using Kaplan-Meier survival curves. Results: Details of 185 patients (alcoholic cirrhosis 106, probable NASH-cirrhosis 79) were available for analysis. Mean survival times of alcoholic cirrhosis and NASH cirrhosis were 309.3 and 95.9 months respectively. There were 26 deaths (21 liver related) in the alcoholic cirrhosis group and 21 deaths (18 liver related) in the probable NASH cirrhosis group. Kaplan-Meier survival curves showed no significant difference in survival between the two groups (logrank test statistic 1.62, p = 0.2). Multivariate analysis using Cox proportional hazards model showed that the predictors of survival were Child-Pugh grade p<0.001) and age at diagnosis (p=0.005). CONCLUSION: The outcome of probable NASH-cirrhosis seems to be similar to that of alcoholic cirrhosis and deaths were mainly liver related.