From the Guidelines
The most common cause of cirrhosis is hepatitis C, with approximately 1.3% of the population having chronic hepatitis C infection. According to the study published in the Journal of the American College of Radiology in 2020 1, hepatitis C is the leading cause of cirrhosis in the United States. This is followed by alcohol-related liver disease and non-alcoholic fatty liver disease (NAFLD), which is rapidly becoming another leading cause, particularly in countries with rising obesity rates.
The progression of hepatic fibrosis to compensated cirrhosis to decompensated cirrhosis can be slow and clinically silent. However, the study published in Gut in 2024 1 highlights that cirrhosis from any cause is the strongest risk factor for the development of hepatocellular carcinoma (HCC), with the reported annual risk of HCC development in cirrhotic patients ranging from 1% to 8%.
Key points to consider include:
- The incidence of HCC appears to be less in alcohol-related cirrhosis and metabolic dysfunction-associated liver disease (MASLD)-related cirrhosis
- Increasing age and male sex are associated risks for HCC development
- Obesity and type 2 diabetes mellitus can cause chronic liver disease and independently increase the risk of HCC development
- Smoking does not cause chronic liver disease but may increase the risk synergistically in those already predisposed to liver disease and cancer
In terms of prevention, maintaining a healthy weight, avoiding high-risk behaviors that can lead to viral hepatitis, and managing underlying conditions like diabetes that contribute to fatty liver disease are crucial. Additionally, complete abstinence from alcohol for those with alcohol-related liver disease is essential. The study published in Hepatology in 2005 1 emphasizes the importance of abstinence in patients with alcoholic liver disease, with more than 85% of transplantation programs in the United States requiring 6 months of abstinence and careful evaluation by professional counselors before transplantation.
From the Research
Causes of Cirrhosis
- The most common causes of cirrhosis include excessive alcohol consumption and metabolic associated steatotic liver disease 2.
- Chronic hepatitis C infection is also a leading cause of chronic liver disease, cirrhosis, hepatocellular carcinoma, and the primary indication for liver transplantation in the United States 3.
- Nonalcoholic fatty liver disease and viral hepatitis are also potential causes of cirrhosis 4.
Role of Alcohol Use Disorders
- Alcohol use disorders (AUDs) are frequent in people with chronic HCV infections and contribute to worsening the course of liver disease 5.
- AUDs are associated with a 3.3-fold risk for progression of liver disease among people with a chronic HCV infection 5.
- Nearly 4 out of 10 decompensated liver cirrhosis cases are attributable to an AUD 5.
Hepatitis C-Related Cirrhosis
- Chronic hepatitis C virus (HCV) infection affects around 150 million people and is a leading cause of liver-related morbidity and mortality 6.
- New treatments based on direct-acting antivirals have opened a new era in the management of HCV cirrhosis, allowing for HCV eradication without substantial side effects in almost all cirrhotic patients 6.
- HCV eradication reduces the risk of hepatocellular carcinoma, liver decompensation, and mortality 6.