Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2019; 25(3): 378-387
Published online Jan 21, 2019. doi: 10.3748/wjg.v25.i3.378
Differential hepatic features presenting in Wilson disease-associated cirrhosis and hepatitis B-associated cirrhosis
Hao-Jie Zhong, Huan-Huan Sun, Lan-Feng Xue, Eileen M McGowan, Yu Chen
Hao-Jie Zhong, Lan-Feng Xue, Yu Chen, Department of Gastroenterology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou 510000, Guangdong Province, China
Hao-Jie Zhong, Department of Gastroenterology, Guangdong Medical University, Zhanjiang 524000, Guangdong Province, China
Huan-Huan Sun, Department of Gastroenterology, The First Affiliated Hospital of Xi’an Jiao Tong University, Xi’an 710000, Shaanxi Province, China
Eileen M McGowan, Faculty of Science, University of Technology Sydney, Sydney NSW 2007, Australia
Author contributions: Zhong HJ, Sun HH, and Chen Y contributed to study conception and design; Zhong HJ, Sun HH, Xue LF, McGowan EM, and Chen Y contributed to data acquisition, data analysis and interpretation, and writing of the article; Zhong HJ, McGowan EM, and Chen Y contributed to editing, reviewing, and final approval of the article.
Supported by the Science and Technology Planning Project of Guangdong Province, No. 2015A030302085 and No. 2016A020212022.
Institutional review board statement: The study was reviewed and approved by the Ethical Committee of the First Affiliated Hospital of Guangdong Pharmaceutical University (2018-72).
Informed consent statement: Informed consent was waived by the Ethical Committee of the First Affiliated Hospital of Guangdong Pharmaceutical University.
Conflict-of-interest statement: There are no conflicts of interest for any of the authors.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at yuchen@gdpu.edu.cn.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared 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/
Corresponding author: Yu Chen, MD, PhD, Doctor, Department of Gastroenterology, The First Affiliated Hospital of Guangdong Pharmaceutical University, No. 19, Nonglinxia Road, Guangzhou 510000, Guangdong Province, China. yuchen@gdpu.edu.cn
Telephone: 86-138-24462875 Fax: +86-020-61325957
Received: December 7, 2018
Peer-review started: December 9, 2018
First decision: December 28, 2018
Revised: January 3, 2019
Accepted: January 9, 2019
Article in press: January 9, 2019
Published online: January 21, 2019

Cirrhosis is a chronic late stage liver disease associated with hepatitis viruses, alcoholism, and metabolic disorders, such as Wilson disease (WD). There are no clear markers or clinical features that define cirrhosis originating from these disparate origins. We hypothesized that cirrhosis is not one disease and cirrhosis of different etiology may have differential clinical hepatic features.


To delineate the liver features between WD-associated cirrhosis and hepatitis B-associated cirrhosis in the Chinese population.


In this observational study, we reviewed the medical data of consecutive inpatients who had WD-associated cirrhosis or hepatitis B-associated cirrhosis from January 2010 to August 2018, and excluded patients who had carcinoma, severe heart or pulmonary diseases, or other liver diseases. According to the etiology of cirrhosis, patients were divided into two groups: WD-associated cirrhosis group (60 patients) and hepatitis B-associated cirrhosis group (56 patients). The liver fibrosis degree, liver function indices, and portal hypertension features of these patients were compared between the two groups.


No inter-group differences were observed in the diagnostic liver fibrosis markers, however, clinical features clearly defined the origin of cirrhosis. WD-associated cirrhosis patients (16-29 years) had lower levels of alanine transaminase, aspartate transaminase, and bilirubin, lower prothrombin time, lower incidence of hepatic encephalopathy, and lower portal vein diameter (P < 0.05), compared to cirrhosis resulting from hepatitis B in older patients (45-62 years). Importantly, they had decreased risks of progression from Child-Pugh grade A to B (odds ratio = 0.046, 95% confidence interval: 0.006-0.387, P = 0.005) and of ascites (odds ratio = 0.08, 95% confidence interval: 0.01-0.48, P = 0.005). Conversely, WD-associated cirrhosis patients had a higher risk of splenomegaly (odds ratio = 4.15, 95% confidence interval: 1.38-12.45, P = 0.011).


WD-associated cirrhosis presents a higher risk of splenomegaly associated with leukopenia and thrombocytopenia, although revealing milder liver dysfunction and portal hypertension symptoms, which recommends WD patients to be monitored for associated complications.

Keywords: Chronic hepatitis B, Cirrhosis, Hepatic feature, Liver function, Portal hypertension, Wilson disease

Core tip: In Asia, especially China, the incidence of Wilson disease (WD) and its complications is much higher in the younger generation compared to Western societies. This article looks beyond the well-characterized, generalized definition of cirrhosis. It addresses an important but simple question: Can the origin of cirrhosis be classified by clinical features, especially in WD-associated cirrhosis? In this manuscript we define specific clinical characteristics of WD-associated cirrhosis in young patients which are very distinct to those of hepatitis-associated cirrhosis in older patients. These important findings may benefit the clinical diagnosis and ultimate treatment of these younger, vulnerable WD patients.