Analysis of Clinical Characteristics and Long-Term Prognosis in Young Patients with Hepatitis B Cirrhosis: A Propensity Score Matched Study

Background: Cirrhosis is rare in young individuals, and clinical differences between young and adult patients remain unclear. This study aimed to evaluate the clinical characteristics and prognosis of HBV-related cirrhosis in young patients. Methods: A hospital-based retrospective cohort of young cirrhosis patients was analyzed. Multivariable analysis identified risk factors for severe complications during follow-up, while the Cox proportional-hazards model assessed the prognosis of young and adult patients with HBV-related cirrhosis. Prognosis was assessed after baseline covariates were balanced using propensity score matching (PSM). Results: The study included 545 patients with cirrhosis, including 119 in the younger group. Young patients with HBV-related cirrhosis exhibited significant differences from adult patients in gender, Alb, ALT, AST, and HBV titer. Kaplan-Meier analysis indicated a higher survival rate in the young group ( P = 0.04); however, no significant difference remained after PSM. Youth was identified as an independent risk factor for gastrointestinal bleeding during follow-up (OR = 3.61, 95% CI: 1.62– 8.00, P = 0.002). Additionally, age and elevated ALP levels were independent risk factors for survival. The Cox-based prediction model showed moderate prognostic performance, with a C-index of 0.69. Conclusion: After baseline differences were balanced, young patients with HBV-related cirrhosis showed no survival advantage. Vigilant monitoring for serious complications, particularly gastrointestinal bleeding, is warranted. These findings may inform targeted interventions to reduce the burden of early onset cirrhosis. Plain Language Summary: Despite preserved liver function, younger patients showed comparable long-term outcomes to elderly after confounder adjustment.Close monitoring for gastrointestinal bleeding remains crucial in younger cases.The developed prognostic model aids hepatitis B cirrhosis management. Keywords: cirrhosis, hepatitis B virus, surveillance, prognosis