Suspected Khat-associated Cirrhosis: Clinical Characteristics of a 28-patient Case Series from a Khat-endemic Region

BACKGROUND: Khat (Catha edulis) is widely consumed in parts of East Africa and the Arabian Peninsula. Although khat-related liver injury has been described, data on the clinical presentation of cirrhosis in patients with chronic khat exposure remain limited. We aimed to describe the clinical characteristics of patients with suspected khat-associated cirrhosis in a khat-endemic region. MATERIALS AND METHODS: We conducted a retrospective case series at a tertiary referral center in southern Saudi Arabia between January 2020 and December 2024. Adult patients with confirmed cirrhosis and documented chronic khat use, in the absence of an alternative dominant etiology, were included. Demographic data, comorbidities, laboratory findings, liver disease severity scores, and cirrhosis-related complications were analyzed descriptively. RESULTS: Twenty-eight patients met the inclusion criteria. The median age was 37 years (interquartile range [IQR] 32-41), and 85.7% were male. Diabetes mellitus and hypertension were present in 14.3% and 10.7%, respectively. The median Model for End-Stage Liver Disease score was 18 (IQR: 11-23), and 82.1% of patients were classified as Child-Pugh class B or C. Cirrhosis-related complications were common: ascites was present in 32.1%, hepatic encephalopathy in 28.6%, gastroesophageal varices in 35.7%, and variceal bleeding in 25.0%. Hepatocellular carcinoma was identified in 7.1% of cases. CONCLUSIONS: In this case series from a khat-endemic region, suspected khat-associated cirrhosis predominantly affected younger males and frequently presented with clinically significant decompensation. These findings are descriptive and hypothesis-generating and highlight the need for prospective studies with standardized exposure assessment and diagnostic criteria.