Non-alkolik steatohepatite bağlı sirozda komplikasyonların ve mortalitenin değerlendirilmesi

Amaç: Non-alkolik yağlı karaciğer hastalığı (NAYKH) saptananhastaların %4-8’inde siroz ve %1-5’inde hepatoselüler karsinom(HCC) nedeni ile ölüm görülmektedir. Bu çalışmada amaç, nonalkoliksteatohepatit (NASH)’e sekonder siroz gelişen hastalarda,siroza ait komplikasyonlar ve mortalite ile ilişkili faktörlerinbelirlenmesidir.Gereçler ve Yöntemler: Çalışmaya, 2008-2018 yıllarıarasında kliniğimizde NASH’e bağlı siroz tanısı alan hastalaralındı. Diyabeti, obezitesi ya da insülin direnci olan ve diğer siroznedenleri dışlanan hastalar NASH’e bağlı siroz olarak kabul edildi.Hastalar prospektif olarak kayıt altına alınıp takip edildi, analizlerretrospektif olarak yapıldı.Bulgular: Çalışmaya toplam 185 hasta dahil edildi. Sağkalım1. yılda %94,6 ve 5. yılda %57,0 bulundu. Median sağkalım 5,83yıl saptandı. HCC’un ortaya çıkması 1. yılda %0,7 ve 5. yılda%9,7 bulundu. Çok değişkenli Cox analizinde yaş (OR 1,12, 95%CI 1,04-1,21; P=0.003), kreatinin (OR 24,4, %95 CI 2,32-257,8;P=0.008) ve ensefalopati (OR 24,49, %95 CI 1.06-19.6; p=0.042)bağımsız prediktörler olarak saptandı. Hastalarda 5. yılda assitgelişimi %46,9, varis kanaması gelişimi %21,9 ve ensefalopatigelişimi %18 saptandı.Sonuç: Non-alkolik steatohepatite sekonder siroz gelişenhastalar HCC, varis kanaması, assit ve ensefalopati gelişimiaçısından dikkatli takip edilmelidir.

Anahtar Kelimeler:

Non-alkolik steatohepatit, Siroz, Mortalite

The evaluation of complications and mortality in non-alcoholic steatohepatitis-related cirrhosis

Objectives: Cirrhosis is seen in 4-8% of patients with nonalcoholicfatty liver disease (NAFLD), and death occurs in 1-5%of them due to hepatocellular carcinoma (HCC). The aim of thisstudy was to determine the factors associated with complicationsand mortality in patients with cirrhosis secondary to non-alcoholicsteatohepatitis (NASH).Materials and Methods: The patients with cirrhosis due toNASH diagnosed between 2008 and 2018 in our clinic formedthe study population. Patients with diabetes, obesity, or insulinresistance and those with cirrhosis due to other causes wereexcluded. The patients were enrolled and followed up prospectively.Results: A total of 185 patients were included in the study.The survival was 94.6% at the 1st year and 57.0% at the 5th year.Median survival duration was 5.83 years. The rate of HCCdevelopment was 0.7% at the 1st year and 9.7% at the 5th year. Inthe multivariate Cox analysis, age (OR: 1.12, 95% CI: 1.04-1.21;P = 0.003), creatinine (OR: 24.4, 95% CI: 2.32-257.8; P= 0.008)and encephalopathy (OR: 24.49, 95% CI: 1.06-19.6; p = 0.042)were found as independent predictors of mortality. Developmentof ascites occurred in 46.9%, variceal bleeding in 21.9% andencephalopathy in 18% of patients at the 5th year.Conclusion: Patients with NASH-related cirrhosis shouldbe carefully monitored for HCC development, variceal bleeding,ascites, and encephalopathy.

Keywords:

Non-alcoholic steatohepatitis, Cirrhosis, Mortality,

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