S2344 Impact of Helicobacter pylori on Liver Outcomes in Cirrhotic Patients

Introduction: Liver cirrhosis is a chronic liver disease that carries a guarded prognosis for affected patients. Helicobacter pylori infection, while primarily known for causing gastrointestinal disease, has been increasingly reported to affect outcomes in patients with chronic liver disease. This study aims to evaluate whether H. pylori infection worsens clinical outcomes in patients with cirrhosis. Methods: We conducted a retrospective cohort study using the TriNetX US Collaborative Network, utilizing data from 69 healthcare organizations. Two cohorts were identified: Cohort 1 included patients with cirrhosis and H. pylori infection (n = 13,282); Cohort 2 included patients with cirrhosis but without H. pylori infection (n = 753,113). Propensity score matching (PSM) was performed between the 2 cohorts based on demographics, comorbidities, elastography, and fibrosis score, resulting in 13,142 matched individuals in each cohort. Outcomes assessed included the development of hepatocellular carcinoma (HCC), ascites, spontaneous bacterial peritonitis (SBP), esophageal varices, hepatorenal syndrome (HRS), hepatic encephalopathy (HE), mortality, and combined liver-related events. Comparative analyses used risk ratios and Kaplan-Meier survival estimates over a 10-year follow-up period, excluding patients with pre-existing outcomes. Results: Patients with H. pylori had significantly higher risks of HCC (RR 1.33; P < 0.001), ascites (RR 1.06; P = 0.03), SBP (RR 1.18; P = 0.008), and HRS (RR 1.29; P < 0.001). Interestingly, H. pylori-infected patients had lower all-cause mortality (RR 0.88; P < 0.001). No significant differences were found for hepatic encephalopathy or combined liver-related events. Conclusion: In cirrhotic patients, H. pylori co-infection correlates with a higher incidence of hepatic decompensation and HCC, yet lower all-cause mortality. These findings suggest an association between H. pylori and liver disease progression, requiring further interventional studies to evaluate the strength of this relationship.