Changing the cause of liver cirrhosis from hepatitis B virus to fatty liver in Iranian patients
Gastroenterology and Hepatology from Bed to Bench,
Aim: The objective of this study was to determine the epidemiologic characteristics of patients with liver cirrhosis.
Background: Liver cirrhosis is an end-stage condition of chronic liver disease. Liver disease is an important cause of morbidity and mortality worldwide.
Methods: In this cross-sectional study, demographic and epidemiologic characteristics of 203 patients with liver cirrhosis who were admitted in Taleghani Hospital over a period of two years were determined.
Results: A total of 203 patients with liver cirrhosis consisted of 136 (67%) males and 67 (33%) females and the mean age was 53.7±15.2 years. No etiology were found in (59.6%) cirrhotic patients; therefore, they were labeled as cryptogenic cirrhosis, but according to clinical evidence and ultrasonography findings, (29.7%) of these patients were probable NAFLD. The other causes of liver cirrhosis in this study were HBV (20.2%), HCV (11.8%) and autoimmune hepatitis (AIH) (8.4%), respectively. Esophageal varices were present in (41.9%), ascites in (36.5%), variceal bleeding in (8.9%), encephalopathy in (7.4%) and spontaneous bacterial peritonitis (SBP) in (5.4%) of patients. When cirrhotic patients were grouped according to Child-Pugh classification, 26.1%, 54.7% and 19.2% were in classes A, B and C respectively. The mean MELD score was 16.16±7.7.
Conclusion: In this study we found that the leading etiology of cirrhosis is cryptogenic cirrhosis 59.6% (in all age groups) and followed by HBV. Noteworthy, according to the clinical and ultrasonography findings, 29.7% of patients who were labeled as cryptogenic cirrhosis were consistent with NAFLD.
- Liver cirrhosis
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Schuppan D, Afdhal NH. Liver cirrhosis. Lancet 2008;371:838-51.
Bellentani S, Tiribelli C. The spectrum of liver disease in the general population: lesson from the Dionysos study. Journal of hepatology 2001;35:531-7.
Anthony PP, Ishak KG, Nayak NC, Poulsen HE, Scheuer PJ, Sobin LH. The morphology of cirrhosis: definition, nomenclature, and classification. Bulletin of the World Health Organization 1977;55:521-40.
Anthony PP, Ishak KG, Nayak NC, Poulsen HE, Scheuer PJ, Sobin LH. The morphology of cirrhosis. Recommendations on definition, nomenclature, and classification by a working group sponsored by the World Health Organization. Journal of clinical pathology 1978;31:395-414.
Hajiani E, Hashemi SJ, Masjedizadeh R, Ahmadzadeh S. Liver Cirrhosis Seen in GI Clinics of Ahvaz, Iran. Govaresh 2012;17:178-82.
Scaglione S, Kliethermes S, Cao G, Shoham D, Durazo R, Luke A, et al. The Epidemiology of Cirrhosis in the United States: A Population-based Study. Journal of clinical gastroenterology 2014.
Clark JM. The epidemiology of nonalcoholic fatty liver disease in adults. Journal of clinical gastroenterology 2006;40 Suppl 1:S5-10.
Ashtari S, Pourhoseingholi MA, Zali MR. Non-alcohol fatty liver disease in Asia: Prevention and planning. World journal of hepatology 2015;7:1788-96.
Farrell GC, Larter CZ. Nonalcoholic fatty liver disease: from steatosis to cirrhosis. Hepatology (Baltimore, Md) 2006;43:S99-s112.
Michitaka K, Nishiguchi S, Aoyagi Y, Hiasa Y, Tokumoto Y, Onji M. Etiology of liver cirrhosis in Japan: a nationwide survey. Journal of gastroenterology 2010;45:86-94.
Blachier M, Leleu H, Peck-Radosavljevic M, Valla DC, Roudot-Thoraval F. The burden of liver disease in Europe: a review of available epidemiological data. Journal of hepatology 2013;58:593-608.
Ashtari S, Pourhoseingholi MA, Sharifian A, Zali MR. Hepatocellular carcinoma in Asia: Prevention strategy and planning. World journal of hepatology 2015;7:1708-17.
Gines P, Cardenas A, Arroyo V, Rodes J. Management of cirrhosis and ascites. The New England journal of medicine 2004;350:1646-54.
de Franchis R, Dell'Era A, Iannuzzi F. Diagnosis and treatment of portal hypertension. Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver 2004;36:787-98.
Suk KT, Kim MY, Park DH, Kim KH, Jo KW, Hong JH, et al. Effect of propranolol on portal pressure and systemic hemodynamics in patients with liver cirrhosis and portal hypertension: a prospective study. Gut and liver 2007;1:159-64.
D'Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. Journal of hepatology 2006;44:217-31.
El-Serag HB, Mason AC. Rising incidence of hepatocellular carcinoma in the United States. The New England journal of medicine 1999;340:745-50.
Fattovich G, Stroffolini T, Zagni I, Donato F. Hepatocellular carcinoma in cirrhosis: incidence and risk factors. Gastroenterology 2004;127:S35-50.
Roberts MS, Angus DC, Bryce CL, Valenta Z, Weissfeld L. Survival after liver transplantation in the United States: a disease-specific analysis of the UNOS database. Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society 2004;10:886-97.
Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology (Baltimore, Md) 2000;31:864-71.
Zhang J, Ye L, Zhang J, Lin M, He S, Mao X, et al. MELD scores and Child-Pugh classifications predict the outcomes of ERCP in cirrhotic patients with choledocholithiasis: a retrospective cohort study. Medicine 2015;94:e433.
UNOS (2009-01-28). "MELD/PELD calculator documentation". Retrieved 2010-02-21.
Baraldi O, Valentini C, Donati G, Comai G, Cuna V, Capelli I, et al. Hepatorenal syndrome: Update on diagnosis and treatment. World journal of nephrology 2015;4:511-20.
Koppel MH, Coburn JW, Mims MM, Goldstein H, Boyle JD, Rubini ME. Transplantation of cadaveric kidneys from patients with hepatorenal syndrome. Evidence for the functionalnature of renal failure in advanced liver disease. The New England journal of medicine 1969;280:1367-71.
Arroyo V, Gines P, Gerbes AL, Dudley FJ, Gentilini P, Laffi G, et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club. Hepatology (Baltimore, Md) 1996;23:164-76.
Ganji A, Malekzadeh F, Safav Mi, Nassri-Moghaddam S, Nourie M, Merat SH, et al. Digestive and Liver Disease Statistics in Iran. Middle East journal of digestive diseases 2009;1:56-62.
Clark JM, Diehl AM. Nonalcoholic fatty liver disease: an underrecognized cause of cryptogenic cirrhosis. Jama 2003;289:3000-4.
Sheth SG, Gordon FD, Chopra S. Nonalcoholic steatohepatitis. Annals of internal medicine 1997;126:137-45.
Bacon BR, Farahvash MJ, Janney CG, Neuschwander-Tetri BA. Nonalcoholic steatohepatitis: an expanded clinical entity. Gastroenterology 1994;107:1103-9.
Wang X, Lin SX, Tao J, Wei XQ, Liu YT, Chen YM, et al. Study of liver cirrhosis over ten consecutive years in Southern China. World journal of gastroenterology : WJG 2014;20:13546-55.
Qua CS, Goh KL. Liver cirrhosis in Malaysia: peculiar epidemiology in a multiracial Asian country. Journal of gastroenterology and hepatology 2011;26:1333-7.
Abedian S, Asl Soleimani H, Saberifiroozi M, Malekzadeh R. Common Digestive and Liver Diseases among 5880 Patients Admitted to Shariati Hospital,Tehran,Iran during 2000-2009. Middle East journal of digestive diseases 2012;4:28-33.
Smolle E, Zohrer E, Bettermann K, Haybaeck J. Viral hepatitis induces hepatocellular cancer: what can we learn from epidemiology comparing iran and worldwide findings? Hepatitis monthly 2012;12:e7879.
Bellentani S, Scaglioni F, Marino M, Bedogni G. Epidemiology of non-alcoholic fatty liver disease. Digestive diseases (Basel, Switzerland) 2010;28:155-61.
Sohrabpour A, Rezvan H, Amini-Kafiabad S, Dayhim M, Merat S, Pourshams A. Prevalence of Nonalcoholic Steatohepatitis in Iran: A Population based Study. Middle East journal of digestive diseases 2010;2:14-9.
Wittenburg H, Tennert U, Berg T. [Complications of liver cirrhosis]. Der Internist 2011;52:1061-70; quiz 71-2.
Awaya H, Mitchell DG, Kamishima T, Holland G, Ito K, Matsumoto T. Cirrhosis: modified caudate-right lobe ratio. Radiology 2002;224:769-74.
Kim WR, Brown RS, Jr., Terrault NA, El-Serag H. Burden of liver disease in the United States: summary of a workshop. Hepatology (Baltimore, Md) 2002;36:227-42.
Gines P, Quintero E, Arroyo V, Teres J, Bruguera M, Rimola A, et al. Compensated cirrhosis: natural history and prognostic factors. Hepatology (Baltimore, Md) 1987;7:122-8.
Powell WJ, Jr., Klatskin G. Duration of survival in patients with Laennec's cirrhosis. Influence of alcohol withdrawal, and possible effects of recent changes in general management of the disease. The American journal of medicine 1968;44:406-20.
D'Amico G, Morabito A, Pagliaro L, Marubini E. Survival and prognostic indicators in compensated and decompensated cirrhosis. Digestive diseases and sciences 1986;31:468-75.
Fernandez J, Navasa M, Gomez J, Colmenero J, Vila J, Arroyo V, et al. Bacterial infections in cirrhosis: epidemiological changes with invasive procedures and norfloxacin prophylaxis. Hepatology (Baltimore, Md) 2002;35:140-8.
Singh N, Wagener MM, Gayowski T. Changing epidemiology and predictors of mortality in patients with spontaneous bacterial peritonitis at a liver transplant unit. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases 2003;9:531-7.
Ribeiro TC, Chebli JM, Kondo M, Gaburri PD, Chebli LA, Feldner AC. Spontaneous bacterial peritonitis: How to deal with this life-threatening cirrhosis complication? Therapeutics and clinical risk management 2008;4:919-25.
Sivanathan V, Kittner JM, Sprinzl MF, Weinmann A, Koch S, Wiltink J, et al. [Etiology and complications of liver cirrhosis: data from a German centre]. Deutsche medizinische Wochenschrift (1946) 2014;139:1758-62.
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