Cirrhosis - Risk Factors

Risk Factors

Cirrhosis affects about 3 million Americans a year. However, because an estimated 2.7 million to 4 million people harbor hepatitis C, experts expect the rates of cirrhosis to dramatically increase over the next few years.

Risk Factors in People with Alcoholism

Only 10% of heavy drinkers develop advanced liver disease. Not eating when drinking and consuming a variety of alcoholic beverages are factors that increase the risk for liver damage. Still, the amount of alcohol consumed and the patterns of drinking are only weak predictions of risk. Other risk factors have been identified that may increase the danger to the liver:

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• Obesity is a major factor for all stages of liver disease.
• Women develop liver disease at lower quantities of alcohol intake than men. The reason for this may be due to women's inability to metabolize alcohol as quickly as men, so it stays in the bloodstream longer.
• Genetic factors that regulate the immune responses in the intestine also play role in increasing the risk for liver injury from alcoholism.

Risk Factors in People with Chronic Hepatitis

Risk Factors for Developing Cirrhosis from Hepatitis C. Overall, between 10 - 15% of patients with chronic hepatitis C develop cirrhosis. The risk varies widely, however. The following conditions put people with hepatitis C at higher risk for liver damage:

• Overall the risk for progression is highest in men -- particularly African Americans -- who were older at the time of infection. The risk is much lower in women and children (2 - 4%).
• Moderate to heavy alcohol users. (Even one or two alcoholic drinks a day increase the risk for liver injury in HCV patients.)
• Having a specific genetic type of the virus. There are six main genetic types and more than 90 subtypes, which can differ significantly in their effects and response to treatment. Genotype 1 is the most serious and is the cause of up to three quarters of the cases in the US. The other common forms are types 2 (15%) and 3 (7%), which pose less danger. (Some evidence suggests that the genetic type is not a primary factor in disease progression, however.)
• Co-infection with hepatitis B. Co-infection with B significantly affects the outcome of these patients and may be more common than previously believed. This co-condition may cause superinfections with very serious consequences, reduce these patients' responses to interferon therapy, and increase their risk of liver cancer. Patients with hepatitis C should be immunized against hepatitis B.
• Co-infection with HIV.
• A history of transfusions. (In one report, the risk in middle-aged patients with a history of transfusions was 20 - 30%).
• Being diabetic and overweight, particularly if fat is distributed in the abdomen (an apple-shape). This condition poses a higher risk for nonalcoholic fatty liver disease (NASH), which in turn is apt to become scarred and cirrhotic.