Copyright
©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
Favorable clinical outcome of nonalcoholic liver cirrhosis patients with coronary artery disease: A population-based study
Ming-Chang Tsai, Tzu-Wei Yang, Chi-Chih Wang, Yao-Tung Wang, Wen-Wei Sung, Ming-Hseng Tseng, Chun-Che Lin
Ming-Chang Tsai, Tzu-Wei Yang, Chi-Chih Wang, Chun-Che Lin, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan
Ming-Chang Tsai, Chi-Chih Wang, Yao-Tung Wang, Wen-Wei Sung, Chun-Che Lin, Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
Ming-Chang Tsai, Tzu-Wei Yang, Chi-Chih Wang, Wen-Wei Sung, Ming-Hseng Tseng, Chun-Che Lin, School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
Tzu-Wei Yang, Institute and Department of Biological Science and Technology, National Chiao Tung University, Hsinchu 300, Taiwan
Yao-Tung Wang, Division of Pulmonary Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan
Wen-Wei Sung, Department of Urology, Chung Shan Medical University Hospital, Taichung 402, Taiwan
Ming-Hseng Tseng, Department of Medical Informatics, Chung Shan Medical University, Taichung 402, Taiwan
Author contributions: All authors reviewed the manuscript and completed final approval; Tsai MC, Yang TW, Tseng MH and Lin CC contributed to study concept and design; Tsai MC, Yang TW and Tseng MH acquired the data; Tsai MC, Yang TW, Wang YT, Sung WW, Tseng MH and Lin CC analyzed and interpreted the data; Tsai MC and Yang TW wrote the manuscript daft; Tsai MC, Yang TW, Wang CC, Wang YT, Sung WW, Tseng MH and Lin CC made critical revision on the manuscript for important intellectual content; Tsai MC, Yang TW and Tseng MH performed statistical analysis; Lin CC obtained funding; Tseng MH and Lin CC contributed to study supervision.
Supported by Chung Shan Medical University Hospital, Taichung, Taiwan, No. CSH- 2013-C-032.
Institutional review board statement: This study was approved by the Institutional Review Board (IRB) of Chung Shan Medical University Hospital, Taiwan.
Informed consent statement: The IRB waived the need of informed consent for this retrospective study based on an encrypted National Health Insurance Research Database (NHIRD).
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: The data of our study were retrieved from the National Health Insurance Research Database (NHIRD) in Taiwan. The application for the data was reviewed and approved by the National Health Insurance (NHI). NHIRD are available via http://nhird.nhri.org.tw/.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Chun-Che Lin, MD, PhD, Professor, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, No.110, Sec. 1, Jianguo N. Rd., South Dist., Taichung 402, Taiwan.
forest65@csmu.edu.tw
Telephone: +886-4-24739595 Fax: +886-4-24739220
Received: April 19, 2018
Peer-review started: April 19, 2018
First decision: June 6, 2018
Revised: July 11, 2018
Accepted: July 16, 2018
Article in press: July 16, 2018
Published online: August 21, 2018
Processing time: 120 Days and 7.2 Hours
AIM
To elucidate the prevalence and risk of mortality of nonalcoholic liver cirrhosis (LC) patients with coronary artery disease (CAD).
METHODS
The study cohort included newly diagnosed nonalcoholic LC patients age ≥ 40 years old without a diagnosis of CAD from 2006 until 2011 from a longitudinal health insurance database. The mean follow-up period for the study cohort was 1152 ± 633 d. The control cohort was matched by sex, age, residence, and index date. Hazard ratios (HRs) were calculated using the Cox proportional hazard model and the Kaplan-Meier method.
RESULTS
After exclusion, a total of 3409 newly diagnosed nonalcoholic cirrhotic patients were identified from one million samples from the health insurance database. We found that CAD (5.1% vs 17.4%) and hyperlipidemia (20.6% vs 24.1%) were less prevalent in nonalcoholic LC patients than in normal subjects (all P < 0.001), whereas other comorbidities exhibited an increased prevalence. Among the comorbidities, chronic kidney disease exhibited the highest risk for mortality (adjusted HR (AHR) = 1.76; 95%CI: 1.55-2.00, P < 0.001). Ascites or peritonitis exhibited the highest risk of mortality among nonalcoholic cirrhotic patients (AHR = 2.34; 95%CI: 2.06-2.65, P < 0.001). Finally, a total of 170 patients developed CAD after a diagnosis of nonalcoholic LC. The AHR of CAD in nonalcoholic LC patients was 0.56 (95%CI: 0.43-0.74, P < 0.001). The six-year survival rates for nonalcoholic LC patients with and without CAD were 52% and 50%, respectively (P = 0.012).
CONCLUSION
We conclude that CAD was less prevalent and associated with a reduced risk of mortality in nonalcoholic cirrhotic patients.
Core tip: Coronary artery disease (CAD) is less prevalent and associated with a reduced risk of mortality in nonalcoholic liver cirrhosis (LC) patients. Nonalcoholic LC patients with CAD exhibit an increased six-year survival rate compared to cirrhotic patients without CAD. The LC complication rates did not differ between nonalcoholic LC patients with and without CAD. Of note, nonalcoholic LC patients with ascites or peritonitis exhibited the highest risk of mortality among LC complications.
