2.2 Data collection
Patient medical data were extracted from the hospital information system
as follows: demographics, alcoholism, smoking status, medical history
(including cirrhosis etiology, diabetes, and hypertension), clinical
presentation, imaging results, and laboratory results including alanine
transaminase (ALT), aspartate transaminase (AST), bilirubin,
serum albumin, lipid profile,
international normalized ratio (INR), prothrombin time (PT), routine
examination of blood, and serum ammonia.
2.3 Definitions
The cirrhosis diagnosis was based on pathologic findings or a
combination of clinical presentation and imaging and laboratory
results.13Chronic HBV infection was defined based on serum hepatitis B surface
antigen positivity for >6 months. Alcohol-related cirrhosis
was defined as cirrhosis together
with alcoholism (alcohol consumption ≥20 g/d in women and ≥40 g/d in men
for >5 years), in the absence of other liver
diseases.14 ACLF
was defined as INR ≥1.5 and serum bilirubin ≥5 mg/dL, complicated by
encephalopathy and/or ascites within 4 weeks, in cirrhotic
patients.15 HE was defined as abnormal
neuropsychiatric manifestations and an abnormal ammonia
level.16 Hypersplenism was defined as imaging results
suggesting splenomegaly and platelet count <120 ×
109/L 17 or a history of splenectomy
owing to hypersplenism.
Leukopenia, thrombocytopenia, and erythropenia were diagnosed based on
white blood cell count <4.0 × 109/L,
platelet count <100 × 109/L, and red blood
cell count <3.5 × 1012/L for females or
<4.0 × 1012/L for males, respectively.
Smoking was defined as a history of smoking for more than 1 year.
Moreover, the duration of liver disease was estimated using age at
alcoholism or HBV infection onset.
2.4 Statistical analyses
Categorical variables are described
as frequency (percentage) and were analyzed with chi-square tests.
Normally distributed continuous variables are
described as mean ± standard
deviation and were analyzed with unpaired two-tailed Student’s t-tests,
while other continuous variables are described as median (interquartile
range) and were analyzed with Mann–Whitney U tests.
Logistic regression with backward
stepwise selection was used to determine the risks of complications by
cirrhosis etiology, adjusting for sex, age, body mass index,
hypertension, diabetes, disease duration, smoking, bilirubin, and
albumin. The results are described as odds ratios (ORs) with 95%
confidence intervals (CIs). P values less than 0.05 (two-tailed)
indicated statistical significance.
SPSS statistical software (version 22; IBM Corporation, Armonk, NY, USA)
was used for all statistical analyses.
3 RESULTS
3.1 Patient characteristics
We retrospectively enrolled a total of 514 cirrhotic patients,
comprising 445 with HBV-related cirrhosis and 69 with alcohol-related
cirrhosis. Table 1 lists their demographic and clinical characteristics.
Among the patients with HBV-related cirrhosis, 401 (90.11%) were taking
antiviral therapy and 156 (60.94%) had a low HBV DNA level (defined as
<2000 IU/mL).
3.2
Differences in hepatic function indexes by cirrhosis etiology
HBV-related cirrhotic patients had a higher rate of Child–Pugh grades B
and C (81.50% vs 18.50%, P = 0.008), and alcohol-related cirrhotic
patients had a lower serum albumin level (32.28 ± 7.02 vs 34.41 ± 6.38
mmol/L, P = 0.017). However, no differences were found in the levels of
AST, ALT, bilirubin, PT, INR, or
blood lipids between the two groups (Table
2).
3.3 Differences in complications
by cirrhosis etiology
The rates of HE and ACLF were
higher in alcohol-related cirrhotic patients than HBV-related
cirrhotic patients (HE: 15.94% vs
4.49%, P = 0.001; ALCF: 7.25% vs 2.28%, P = 0.040). The serum ammonia
level was also higher in alcohol-related cirrhotic patients with HE than
HBV-related cirrhotic patients with HE (134.00 ± 62.99 vs 82.16 ± 17.82
μmol/L, P = 0.029). In contrast, the
rates of HCC and
hypersplenism were higher in
HBV-related cirrhotic patients than alcohol-related cirrhotic
patients (HCC: 39.55% vs 1.45%, P
< 0.001; hypersplenism: 45.84% vs 28.99%, P = 0.009). No
significant differences in the rates of jaundice, ascites, esophageal
and gastric varices, or spontaneous peritonitis were observed between
the two groups (Table 3).