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Idilman R, Aydogan M, Oruncu MB, Kartal A, Elhan AH, Ellik Z, Gumussoy M, Er R, Ozercan M, Duman S, Toruner M, Cinar K, Soykan I, Beyler AR, Ozkan H. Natural History of Cirrhosis: Changing Trends in Etiology Over the Years. Dig Dis 2020; 39:358-365. [PMID: 33142287 DOI: 10.1159/000512746] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/02/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND GOALS The aims of the present study were to investigate the natural history of cirrhosis and to determine trends in the etiology of cirrhosis. METHODS Between January 2001 and January 2018, a total of 1,341 patients had been diagnosed with cirrhosis and were included. RESULTS A total of 898 cirrhotic patients, who were followed up for at least 6 months were included into the analysis. The median age was 54 years. The median Child-Pugh and MELD scores were 7.5 and 11, respectively. Ascites (51%) was the most common causes of decompensation. Chronic viral hepatitis was the most frequent cause of cirrhosis (58%). Hepatitis B virus (HBV) infection was the main etiology (34%), followed by hepatitis C virus (HCV) infection (18%). Among 129 patients with cryptogenic cirrhosis (CC), 60 had metabolic abnormalities. If these 60 patients with CC were considered to have nonalcoholic fatty liver disease (NAFLD)-related cirrhosis, the proportion of NAFLD-related cirrhosis increased from 1.8 to 8.0%. At admission, 74 patients (8%) had been diagnosed with hepatocellular carcinoma (HCC). A new HCC developed in 80 patients during the follow-up period. The probability of developing HCC was 3.9% at 12 months. Logistic regression analysis showed that the development of HCC was significantly associated with older age (p < 0.001), male gender (p < 0.001), viral etiology (p = 0.026), and baseline high aspartate aminotransferase level (p = 0.01). Overall, 104 cirrhotic patients died. CONCLUSION HBV and HCV remain the leading causes of etiology in cirrhosis and HCC. However, NAFLD-related cirrhosis is recognized as a growing burden.
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Affiliation(s)
- Ramazan Idilman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey,
| | - Merve Aydogan
- Department of Internal Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Mehmet Berk Oruncu
- Department of Internal Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Aysun Kartal
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Atilla Halil Elhan
- Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey
| | - Zeynep Ellik
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Mesut Gumussoy
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Ramazan Er
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Mubin Ozercan
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Serkan Duman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Murat Toruner
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Kubilay Cinar
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Irfan Soykan
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Ali Resit Beyler
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Hasan Ozkan
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
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