Epidemiology

Nonalcoholic steatohepatitis less deadly than hepatitis C

Last Updated: 2006-04-11 15:33:26 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - Compensated cirrhosis resulting from nonalcoholic steatohepatitis (NASH) is associated with lower mortality rates than is hepatitis C, but cardiovascular mortality is more common with NASH, according to a report in the April issue of Hepatology.

"We were somewhat surprised by the findings," Dr. Arun J. Sanyal told Reuters Health.

"It shows that the rate of decompensation in subjects with cirrhosis due to NASH who have normal liver function is somewhat slower than hepatitis C," pointed out the researcher from Virginia Commonwealth University Medical Center, Richmond. "This may be due to more aggressive inflammation in hepatitis C. However, once decompensation occurs, the prognosis is equally poor for the two groups."

Dr. Sanyal and colleagues investigated clinical outcomes of cirrhosis due to NASH in 152 patients and compared them with those associated with hepatitis C virus (HCV) infection in 150 matched patients.

Hepatic steatosis was consistently present in NASH patients, but affected only a fifth of HCV patients, the authors report.

Over 10 years of observation, 3 of 74 (4%) patients with NASH and compensated cirrhosis died, compared with 15 of 75 (20%) patients with HCV.

NASH patients were less likely than HCV-infected patients to develop decompensated cirrhosis over 10 years of follow-up, the results indicate. Once decompensated cirrhosis developed, however, there were no significant differences in mortality between the two groups.

Cardiovascular mortality was significantly higher among NASH patients than among patients with HCV, the researchers note.

"NASH is associated with the metabolic syndrome," Dr. Sanyal pointed out. "It is, therefore, expected that the cardiac mortality is increased in these patients. It is, therefore, worthwhile to evaluate the other end organs affected by the metabolic syndrome in patients with NASH."

Compared with HCV-infected patients, NASH patients were less likely to develop ascites or liver cancer, the report indicates, and they showed a trend toward having less encephalopathy. The risk of variceal hemorrhage was similar in the two groups.

"While the risk of liver cancer was less than in HCV, liver cancer did occur and one should not entertain the notion that NASH and cirrhosis is not associated with hepatocellular carcinoma," Dr. Sanyal commented.

Hepatology 2006;43:682-689.