Asfari Mohammad Maysara, Talal Sarmini Muhammad, Alomari Mohammad, Lopez Rocio, Dasarathy Srinivasan, McCullough Arthur J
Department of Gastroenterology, Medical College of Georgia/Augusta University, Augusta, Georgia.
Department of Internal Medicine.
Eur J Gastroenterol Hepatol. 2020 Dec;32(12):1566-1570. doi: 10.1097/MEG.0000000000001681.
Current guidelines recommend surveillance for hepatocellular carcinoma (HCC) in high-risk patients. This high risk is defined by the presence of cirrhosis. However, HCC due to underlying nonalcoholic steatohepatitis (NASH), even without progressing to cirrhosis, is a rising concern. Hence, we aimed to determine the association of HCC with NASH using a large national database.
A cross-sectional study was performed using the 2012 National Inpatient Sample. The study group was all adult patients' age 18-90 years who have a diagnosis of NASH which was identified using the International Classification of Diseases 9th version (ICD-9) codes. The control group included the rest of adult individuals without discharge records of NASH. We identified the diagnosis of HCC in both study and control groups using the ICD-9 codes. We calculated the association between NASH and HCC using univariable and multivariate logistic regression.
Totally, 30 712 524 hospitalizations were included in our study. This cohort included 218 950 patients with NASH (study group) and 30 493 574 patients without NASH (control group). The study group patients aged 57.3 ± 0.10 years (59.4% females) comparing to 54.5 ± 0.11 years (57.1% female) in the control group. HCC prevalence in subjects with NASH was 0.50% [95% confidence interval (CI): 0.41-0.59] compared to 0.21% (95% CI: 0.20-0.23) in subjects without NASH (P < 0.001). After adjusting for age, gender, smoking, alcohol use, obesity, hepatitis C virus, hepatitis B virus, hemochromatosis, HIV, cirrhosis and the modified comorbidity index, subjects with NASH were 60% more likely to have HCC than those without NASH (adjusted odds ratio: 1.6, 95% CI: 1.4-1.9, P < 0.001).
Our study showed that NASH patients are 60% more likely to develop HCC compared with patients without NASH. Close monitoring and even periodical surveillance might be needed.
当前指南建议对高危患者进行肝细胞癌（HCC）监测。这种高风险由肝硬化的存在来定义。然而，由潜在的非酒精性脂肪性肝炎（NASH）引起的HCC，即使未进展为肝硬化，也日益受到关注。因此，我们旨在使用一个大型国家数据库来确定HCC与NASH之间的关联。
使用2012年全国住院患者样本进行了一项横断面研究。研究组为所有年龄在18 - 90岁、诊断为NASH的成年患者，NASH通过国际疾病分类第9版（ICD - 9）编码确定。对照组包括其余无NASH出院记录的成年个体。我们使用ICD - 9编码在研究组和对照组中确定HCC的诊断。我们使用单变量和多变量逻辑回归计算NASH与HCC之间的关联。
我们的研究共纳入30712524例住院病例。该队列包括218950例NASH患者（研究组）和30493574例无NASH患者（对照组）。研究组患者年龄为57.3±0.10岁（女性占59.4%），而对照组为54.5±0.11岁（女性占57.1%）。NASH患者中HCC患病率为0.50%[95%置信区间（CI）：0.41 - 0.59]，而无NASH患者中为0.21%（95%CI：0.20 - 0.23）（P < 0.001）。在调整年龄、性别、吸烟、饮酒、肥胖、丙型肝炎病毒、乙型肝炎病毒、血色素沉着症、HIV、肝硬化和改良合并症指数后，NASH患者发生HCC的可能性比无NASH患者高60%（调整后的优势比：1.6，95%CI：1.4 - 1.9，P < 0.001）。
我们的研究表明，与无NASH的患者相比，NASH患者发生HCC的可能性高60%。可能需要密切监测甚至定期进行筛查。
