Etiologies and clinical features of liver cirrhosis in Lanzhou,China

Objective To investigate the etiologies and clinical features of patients with liver cirrhosis in Lanzhou,China and the risk factors for liver cirrhosis with primary liver cancer. Methods A retrospective analysis was performed for the medical records of 3496 patients with liver cirrhosis who were diagnosed and treated in Department of Infectious Diseases,The First Hospital of Lanzhou University,from April 2015 to April 2018,including sex,age,family history,past history,personal history,etiology,clinical manifestation,complication,and laboratory examination. The chi-square test was used for comparison of categorical data between groups,and the multivariate logistic regression analysis was used to investigate the risk factors for liver cirrhosis with liver cancer. Results Among the 3496 patients with liver cirrhosis,2209( 63. 19%) had hepatitis B,among whom 2032 patients had complete HBe Ag data,with 807( 39. 71%) HBe Ag-positive patients and 1225( 60. 29%) HBe Ag-negative patients; among these 2209 patients,2207 had HBV DNA data,among whom 1567( 71. 00%) had positive HBV DNA. There were 309 patients( 8. 84%) with hepatitis C,144 patients( 4. 12%) with autoimmune hepatitis,133 patients( 3. 80%)with primary biliary cholangitis,93 patients( 2. 66%) with alcoholic cirrhosis,and 447 patients( 12. 79%) with cryptogenic cirrhosis. Major clinical manifestations included splenomegaly and/or hemocytopenia in 2299 patients( 65. 76%),ascites in 1760 patients( 50. 34%),esophageal varices in 1647 patients( 47. 11%),gastric varices in 1386 patients( 39. 66%),and jaundice in 754 patients( 21. 57%). The main complications included primary liver cancer in 937 patients( 26. 80%),gastrointestinal bleeding in 822 cases( 23. 51%),infection in 697 patients( 19. 94%) [mainly pulmonary infection in 487 patients( 13. 93%) ],and hepatic encephalopathy in 261 patients( 7. 47%). The patients with hepatitis B cirrhosis had a significantly higher incidence rate of primary liver cancer than those with alcoholic hepatitis cirrhosis( χ2= 26. 854,P < 0. 001); the patients with alcoholic cirrhosis had a significantly higher incidence rate of gastrointestinal bleeding than those with hepatitis B cirrhosis( χ2= 5. 031,P = 0. 025); the patients with hepatitis B cirrhosis had a significantly lower incidence rate of hepatic encephalopathy than those with alcoholic cirrhosis( χ2= 40. 903,P < 0. 001). Among the patients with a confirmed diagnosis of primary liver cancer,73. 22% had positive alpha-fetoprotein( AFP) and 26. 78% had negative AFP. Age( odds ratio [OR]= 1. 025,95% confidence interval[CI]: 1. 017-1. 034,P <0. 05),male sex( OR =2. 701,95% CI: 2. 168-3. 365,P <0. 05),positive HBV DNA( OR =1. 361,95% CI:1. 123-1. 649,P < 0. 05),hypertension( OR = 2. 372,95% CI: 1. 845-3. 050,P < 0. 05),and a family history of liver cancer( OR =2. 261,95% CI: 1. 255-4. 075,P < 0. 05) were risk factors for primary liver cancer in patients with liver cirrhosis. Conclusion Hepatitis B is the main etiology of liver cirrhosis in Lanzhou,followed by hepatitis C and autoimmune liver disease. The main clinical manifestations are splenomegaly and/or hemocytopenia,and the main complication is primary liver cancer. Active antiviral therapy and prevention of hypertension may help to reduce the risk of primary liver cancer in patients with liver cirrhosis.