Prevalence and predictors of cirrhosis and portal hypertension in the united states

Abstract

Background and aim: There is paucity of data about the prevalence of cirrhosis and portal hypertension in the US general population. Methods: We used National Health and Nutrition Examination Surveys (NHANES 2017-2020) to estimate the prevalence of cirrhosis and clinically significant (CS)-portal hypertension in alcoholic liver disease (ALD), MetALD, viral hepatitis (VH) to include chronic hepatitis B (CHB) and chronic hepatitis C (CHC), and metabolic dysfunction-associated steatotic liver disease (MASLD). Cirrhosis was evaluated using liver stiffness measurement (LSM) by transient elastography or FIB-4 score; CS-portal hypertension was defined via LSM and platelet count or the use of non-selective beta-blockers in the presence of cirrhosis. Results: The prevalence of CLD etiologies was ALD 0.85%, MetALD 3.38%, CHB 0.23%, CHC 0.73%, ALD+VH 0.16%, MASLD 33.05%. In general population, the prevalence of ALD-cirrhosis was 0.08%, MetALD-cirrhosis 0.19%, CHB-cirrhosis 0.01%, CHC-cirrhosis 0.10%, MASLD-cirrhosis 1.27%, ALD+VH-cirrhosis 0.08%, and other cirrhosis 0.87%. The prevalence of CS-portal hypertension in CLD was: 1.31% in MetALD, 1.60% in CHB, 4.73% in CHC, 2.00% in MASLD, and 0.35% in controls, to yield the population prevalence of 0.98%. In multivariate analysis, excessive alcohol use, CHC, male sex, obesity, type 2 diabetes, and hypertension were independently associated with an increased risk of cirrhosis (all P<0.05). Predictors of having CS-portal hypertension in CLD included CHC, obesity, and type 2 diabetes (all P<0.05). Conclusions: The prevalence of cirrhosis in the U.S. is 2.6% while the prevalence of CS-portal hypertension is 0.98%. Individuals with MASLD comprise the majority of U.S. residents with cirrhosis.