Published online Jan 21, 2019. doi: 10.3748/wjg.v25.i3.378
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). As the etiology and onset age of WD-associated cirrhosis are different from those of other kinds of liver cirrhosis, WD-associated cirrhosis may involve a distinct liver injury pathogenesis.
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.
We performed a cross-sectional study of 60 WD-associated cirrhosis and 56 hepatitis B-associated cirrhosis inpatients. We analyzed the liver fibrosis degree, liver function indices, and portal hypertension features between these two groups.
No inter-group differences were observed in the diagnostic liver fibrosis markers, however, clinical features clearly defined the origin of cirrhosis. Cirrhosis presenting in WD patients had worse liver function, lower incidence of hepatic encephalopathy, and lower portal vein diameter, compared to cirrhosis resulting from hepatitis B. They had decreased risks of progression from Child-Pugh grade A to B and of ascites. Conversely, WD-associated cirrhosis patients had a higher risk of splenomegaly, which was associated with a significantly increased risk of leukopenia and thrombocytopenia.
WD-associated cirrhosis presents a higher risk of splenomegaly associated with leukopenia and thrombocytopenia, although revealing milder liver dysfunction and portal hypertension symptoms. These findings indicated that cirrhosis is not one disease and further classification for diagnosis and treatment options, dependent on origin, are needed.
The higher risk of splenomegaly associated with leucopenia and thrombocytopenia in these younger, vulnerable WD patients with cirrhosis, suggests early and regular monitoring of associated blood disorders and infections to alleviate further clinical complications.