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Cirrhosis

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of cirrhosis

Risk Factors

Cirrhosis affects about 3 million Americans a year. However, because an estimated 2.7 million to 4 million people harbor hepatitis C, experts expect the rates of cirrhosis to dramatically increase over the next few years.

Risk Factors in People with Alcoholism

Only 10% of heavy drinkers develop advanced liver disease. Not eating when drinking and consuming a variety of alcoholic beverages are factors that increase the risk for liver damage. Still, the amount of alcohol consumed and the patterns of drinking are only weak predictions of risk. Other risk factors have been identified that may increase the danger to the liver:

• Obesity is a major factor for all stages of liver disease.
• Women develop liver disease at lower quantities of alcohol intake than men. The reason for this may be due to women's inability to metabolize alcohol as quickly as men, so it stays in the bloodstream longer.
• Genetic factors that regulate the immune responses in the intestine also play role in increasing the risk for liver injury from alcoholism.

Risk Factors in People with Chronic Hepatitis

Risk Factors for Developing Cirrhosis from Hepatitis C. Overall, between 10 - 15% of patients with chronic hepatitis C develop cirrhosis. The risk varies widely, however. The following conditions put people with hepatitis C at higher risk for liver damage:

• Overall the risk for progression is highest in men -- particularly African Americans -- who were older at the time of infection. The risk is much lower in women and children (2 - 4%).
• Moderate to heavy alcohol users. (Even one or two alcoholic drinks a day increase the risk for liver injury in HCV patients.)
• Having a specific genetic type of the virus. There are six main genetic types and more than 90 subtypes, which can differ significantly in their effects and response to treatment. Genotype 1 is the most serious and is the cause of up to three quarters of the cases in the US. The other common forms are types 2 (15%) and 3 (7%), which pose less danger. (Some evidence suggests that the genetic type is not a primary factor in disease progression, however.)
• Co-infection with hepatitis B. Co-infection with B significantly affects the outcome of these patients and may be more common than previously believed. This co-condition may cause superinfections with very serious consequences, reduce these patients' responses to interferon therapy, and increase their risk of liver cancer. Patients with hepatitis C should be immunized against hepatitis B.
• Co-infection with HIV.
• A history of transfusions. (In one report, the risk in middle-aged patients with a history of transfusions was 20 - 30%).
• Being diabetic and overweight, particularly if fat is distributed in the abdomen (an apple-shape). This condition poses a higher risk for nonalcoholic fatty liver disease (NASH), which in turn is apt to become scarred and cirrhotic.

• Having large iron stores in the liver.
• High exposure to toxic chemicals or environmental contaminants.

Because there are millions of Americans now infected with chronic hepatitis C, experts have been justifiably concerned that there will be a significant number of cases of liver failure and liver cancer in the coming years. Computer analyses have suggested that mortality rates from HCV-related cirrhosis or liver cancer will double or triple over the next 20 years. Fortunately, improved therapies may significantly reduce these discouraging estimates.

Risk Factors for Developing Cirrhosis from Hepatitis B. The great majority of people with chronic persistent hepatitis B have a good long-term outlook. Between 5 - 10%, however, become carriers of the virus, and 5 - 10% of these individuals eventually develop cirrhosis. The addition of hepatitis D is a particular danger and increases the risk for cirrhosis. Seven genetic types of hepatitis B virus (designated A to G) have now been identified, which may help researchers determine the patients who may have a better outlook than others. Genotype C is the most common form and is more aggressive than genotype B, which also responds better to treatment.

Risk Factors for Cirrhosis in Autoimmune Liver Diseases

Primary biliary cirrhosis accounts for only 0.6 - 2% of deaths from cirrhosis. In patients with chronic persistent autoimmune hepatitis, the outlook is very favorable and survival rates are equal to the general population. If it becomes active, it must be treated. Left untreated, the 5-year survival rates of primary biliary cirrhosis are 50%.

Obesity and Other Risk Factors for Cirrhosis

A 2003 study of more than 11,000 patients, published in the journal Gastroenterology , revealed that obesity increased the risk of death from cirrhosis in those who drank little or no alcohol, but not in alcoholics. Previous evidence has suggested that severe obesity and diabetes are major risk factors for cirrhosis in nonalcoholic steatohepatitis (NASH) patients. (Severe obesity in any case is a risk factor for liver damage and in one study, 2.3% of patients with severe obesity had signs of cirrhosis.) Men are at higher risk than women, and African Americans have a higher risk than Caucasians. Patients with NASH-associated cirrhosis generally do better than patients with alcohol-related liver damage, however.

• Review Date: 8/18/2006
• Reviewed By: Harvey Simon, M.D., Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital.

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