Patients with NASH-related decompensated cirrhosis demonstrate better mortality outcomes - Healio

SAN DIEGO – Decompensated cirrhosis due to non-alcoholic steatohepatitis may predict lower 90-day mortality compared with decompensated cirrhosis that results from other causes, according to findings presented at Digestive Disease Week.

“Patients with compensated cirrhosis due to NASH have been shown to have lower mortality than those with other underlying etiologies,” the researchers wrote. “Patients with decompensated cirrhosis, however, are thought to have similar pathophysiologic changes, leading to high 90-day mortality regardless of the underlying etiology of cirrhosis.”

Diana Hatamleh, MD, a resident at the University of Florida, and colleagues retrospectively identified patients admitted to a tertiary referral center for decompensated cirrhosis between January 2010 and January 2017. The researchers obtained data on patient demographics, baseline patient characteristics, MELD scores, reason for hospital admission and cirrhosis etiology.

Ninety-day mortality served as the primary outcome. Secondary outcomes included 90-day readmission, length of stay and transfer to the intensive care unit during the index admission.

The researchers obtained data on 630 patients who were admitted for decompensated cirrhosis. Of those patients, 11.8% (n = 74) had cirrhosis due to NASH. Additional causes of cirrhosis included alcoholism (41.4%; n = 261), hepatitis C (31.7%; n = 200) and other etiologies (15.1%; n = 95).

Patients with NASH-related decompensated cirrhosis were more likely to be older than patients with cirrhosis due to other etiologies (60.8 years vs. 56.7 years; both ±10 years). The number of comorbidities between the two groups were similar.

Rates of 90-day mortality were significantly lower among patients with decompensated cirrhosis due to NASH compared with decompensated cirrhosis due to other etiologies (8% vs. 20%, P = .015). Additionally, a multivariate logistic regression model that adjusted for age, sex, MELD score and comorbidities demonstrated that patients with decompensated cirrhosis due to NASH had significantly lower odds of 90-day mortality compared with other etiologies (OR, 0.3; 95% CI, 0.12-0.72). No significant differences in secondary outcomes were noted.

The reasons for the lower mortality rates among patients with decompensated cirrhosis due to NASH compared with other etiologies are “unclear,” Hatamleh told Healio Gastroenterology, adding that there is limited literature on this issue. However, there are several hypotheses.

“The biggest hypothesis is that patients with NASH are usually obese and, in general, obese patients who are admitted to the hospital usually have better mortality, no matter what they’re admitted for,” Hatamleh said. “These patients have more inflammatory markers and other related characteristics. In addition, patients with hepatitis C and patients who are alcoholics usually have other issues that make them sicker, although patients with NASH-related cirrhosis have more comorbidities and they’re usually older. We controlled for the MELD scores and they were comparable, so that doesn’t explain it.”

The next step for this research involves larger trials that confirm that patients with NASH-related decompensated cirrhosis have better outcomes regarding 90-day mortality, Hatamleh continued.

“If bigger studies confirm these findings, we can include the cause of cirrhosis in calculating a patient’s MELD score, which predicts 90-day mortality,” she said. - by Julia Ernst, MS

Reference:

Hatamleh D, et al. Abstract Sa1616. Presented at: Digestive Disease Week; May 18-21, 2019; San Diego.

Disclosures: The authors report no relevant financial disclosures.

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