Published online Aug 21, 2018. doi: 10.3748/wjg.v24.i31.3547
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
To elucidate the prevalence and risk of mortality of nonalcoholic liver cirrhosis (LC) patients with coronary artery disease (CAD).
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.
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).
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.