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Development of liver failure. Hepatic decompensation and liver failure were defined in several ways:
(1) development of ascites, variceal hemorrhage or hepatic encephalopathy; (2) progression from CPT
stage A to B or a 2-point increase in score; (3) decline in liver function (worsening hyperbilirubinemia,
hypoprothrombinemia), and (4) development of HCC.
1. Development of ascites variceal hemorrhage and hepatic encephalopathy.
In subjects with NASH related cirrhosis, ascites is the first clinical feature of decompensation. It is also
the most common complication of cirrhosis (Fig. 2) [5]. It occurs however at a slower rate than in those
with HCV related cirrhosis. The future rates of development of hepatorenal syndrome were similar to
those in HCV related cirrhosis once ascites developed.
The rates of development of varices were similar in those with NASH related cirrhosis and HCV related
cirrhosis [5]. The rates of development of variceal hemorrhage were also not significantly different.
Variceal hemorrhage was the least common complication of cirrhosis in this population. This may
be related to the aggressive use of primary prophylaxis in those who were identified to have varices
and reflects national trends of declining rates of variceal hemorrhage. The presence of varices was
independently predicted by MELD score and low platelet counts in those with NASH-related cirrhosis.
The rates of development of hepatic encephalopathy (HE) were intermediate between those for ascites
and variceal hemorrhage. No deaths were directly attributable to HE in the absence of sepsis. The
MELD score was independently associated with the development of HE (Fig. 2).
Figure 2. Complications due to cirrhosis related to NASH.
2. Progression of CPT score.
Subjects with NASH decompensate at a somewhat slower rate than those with HCV related cirrhosis
with respect to a 2-point worsening of their CPT score [5]. The lower rate of development of ascites
drives much of this difference. In those with NASH related cirrhosis, hypoalbuminemia and development
of ascites were the principal causes of a 2 point or greater increment in CPT scores.
104 Postgraduate Course Syllabus • Metabolic Liver Disease
(1) development of ascites, variceal hemorrhage or hepatic encephalopathy; (2) progression from CPT
stage A to B or a 2-point increase in score; (3) decline in liver function (worsening hyperbilirubinemia,
hypoprothrombinemia), and (4) development of HCC.
1. Development of ascites variceal hemorrhage and hepatic encephalopathy.
In subjects with NASH related cirrhosis, ascites is the first clinical feature of decompensation. It is also
the most common complication of cirrhosis (Fig. 2) [5]. It occurs however at a slower rate than in those
with HCV related cirrhosis. The future rates of development of hepatorenal syndrome were similar to
those in HCV related cirrhosis once ascites developed.
The rates of development of varices were similar in those with NASH related cirrhosis and HCV related
cirrhosis [5]. The rates of development of variceal hemorrhage were also not significantly different.
Variceal hemorrhage was the least common complication of cirrhosis in this population. This may
be related to the aggressive use of primary prophylaxis in those who were identified to have varices
and reflects national trends of declining rates of variceal hemorrhage. The presence of varices was
independently predicted by MELD score and low platelet counts in those with NASH-related cirrhosis.
The rates of development of hepatic encephalopathy (HE) were intermediate between those for ascites
and variceal hemorrhage. No deaths were directly attributable to HE in the absence of sepsis. The
MELD score was independently associated with the development of HE (Fig. 2).
Figure 2. Complications due to cirrhosis related to NASH.
2. Progression of CPT score.
Subjects with NASH decompensate at a somewhat slower rate than those with HCV related cirrhosis
with respect to a 2-point worsening of their CPT score [5]. The lower rate of development of ascites
drives much of this difference. In those with NASH related cirrhosis, hypoalbuminemia and development
of ascites were the principal causes of a 2 point or greater increment in CPT scores.
104 Postgraduate Course Syllabus • Metabolic Liver Disease
