Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.
Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore.
Am J Gastroenterol. 2021 Jul 1;116(7):1437-1446. doi: 10.14309/ajg.0000000000001176.
Decompensation with ascites portends a poor prognosis in cirrhosis. The aim of this study was to compare the outcomes of patients with nonalcoholic steatohepatitis (NASH) with hepatitis B virus (HBV) cirrhosis after decompensation with ascites.
We conducted a retrospective study to evaluate the outcomes of patients with NASH and HBV cirrhosis who were admitted to hospital for first-onset ascites from January 1, 2004, to June 30, 2015. They were followed up until death, liver transplantation, or loss to follow up.
Patients with NASH had lower median (interquartile range) Model for End-Stage Liver Disease score (11 [9-14] vs 14 [11-17], P < 0.001). Over 60 months, patients with NASH cirrhosis had higher cumulative incidence of dilutional hyponatremia (P < 0.001) and refractory ascites (P = 0.028). They also had higher cumulative incidence of cirrhosis-related deaths and liver transplantation compared with HBV cirrhosis (65.7%; [95% confidence interval (CI) 53.6-75.4] vs 42.5% [95% CI 32.4-55.2], P = 0.008). Multivariable competing risk analysis showed that NASH (subdistribution hazard ratio [sHR] 1.88 [95% CI 1.14-3.11], P = 0.014), non-Chinese ethnicity (sHR 1.63 [95% CI 1.06-2.50], P = 0.027), history of hepatocellular carcinoma (sHR 1.76 [95% CI 1.05-2.95], P = 0.033), estimated glomerular filtration rate <60 mL/min/1.73 m2 (sHR 1.70 [95% CI 1.09-2.65], P = 0.020), and Model for End-Stage Liver Disease score ≥15 (sHR 3.26 [95% CI 2.11-5.05], P < 0.001) were independent predictors of poor transplant-free survival.
Patients with decompensated cirrhosis due to NASH had much poorer prognosis compared with HBV with more complications and greater healthcare resource utilization. Greater awareness is necessary for early diagnosis of NASH before decompensation.
伴有腹水的失代偿预示着肝硬化预后不良。本研究旨在比较非酒精性脂肪性肝炎（NASH）与乙型肝炎病毒（HBV）肝硬化患者腹水失代偿后的结局。
我们进行了一项回顾性研究，评估了 2004 年 1 月 1 日至 2015 年 6 月 30 日因首次发生腹水而住院的 NASH 和 HBV 肝硬化患者的结局。随访至死亡、肝移植或失访。
NASH 患者的中位（四分位距）终末期肝病模型评分较低（11 [9-14] 与 14 [11-17]，P < 0.001）。在 60 个月时，NASH 肝硬化患者稀释性低钠血症（P < 0.001）和难治性腹水（P = 0.028）的累积发生率更高。与 HBV 肝硬化相比，NASH 肝硬化患者的肝硬化相关死亡率和肝移植率更高（65.7%[95%置信区间（CI）53.6-75.4]与 42.5%[95%CI 32.4-55.2]，P = 0.008）。多变量竞争风险分析显示，NASH（亚分布危险比[ sHR] 1.88 [95%CI 1.14-3.11]，P = 0.014）、非中国种族（sHR 1.63 [95%CI 1.06-2.50]，P = 0.027）、肝细胞癌病史（sHR 1.76 [95%CI 1.05-2.95]，P = 0.033）、估计肾小球滤过率<60 mL/min/1.73 m2（sHR 1.70 [95%CI 1.09-2.65]，P = 0.020）和终末期肝病模型评分≥15 （sHR 3.26 [95%CI 2.11-5.05]，P < 0.001）是无移植生存的独立预测因素。
与 HBV 相比，由于 NASH 导致失代偿的肝硬化患者并发症更多，医疗资源利用更多，预后更差。在 NASH 失代偿之前，需要提高对其进行早期诊断的认识。
