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Alcohol associated liver cirrhotics have higher mortality after index hospitalization: Long-term data of 5,138 patients

Rakhi Maiwall|Ashok Kumar Choudhury|Vinod Arora|Shiv Kumar Sarin|Guresh Kumar|Manoj Kumar Sharma|Saggere Muralikrishna Shasthry|Ankur Jindal|Priyanka Jain|Ankit Bharadwaj|Rajan Vijayaraghavan|Vikram Bhatia
대한간학회 (The korean Association for the Study of the Liver)|2021.01|Clinical and Molecular Hepatology|제27권 제1호|pp. 175-185|DOI 10.3350/cmh.2020.0068

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키워드

MortalityMorbidityBleedingAscitesCirrhosis

초록

Background/Aims: Liver cirrhosis is an important cause of morbidity and mortality globally. Every episode of decompensation and hospitalization reduces survival. We studied the clinical profile and long-term outcomes comparing alcohol-related cirrhosis (ALC) and non-ALC. Methods: Cirrhosis patients at index hospitalisation (from January 2010 to June 2017), with ≥1 year follow-up were included. Results: Five thousand and one hundred thirty-eight cirrhosis patients (age, 49.8±14.6 years; male, 79.5%; alcohol, 39.5%; Child-A:B:C, 11.7%:41.6%:46.8%) from their index hospitalization were analysed. The median time from diagnosis of cirrhosis to index hospitalization was 2 years (0.2–10). One thousand and seven hundred seven patients (33.2%) died within a year; 1,248 (24.3%) during index hospitalization. 59.5% (2,316/3,890) of the survivors, required at least one readmission, with additional mortality of 19.8% (459/2,316). ALC compared to non-ALC were more often (P<0.001) male (97.7% vs. 67.7%), younger (40–50 group, 36.2% vs. 20.2%; P<0.001) with higher liver related complications at baseline, (P<0.001 for each), sepsis: 20.3% vs. 14.9%; ascites: 82.2% vs. 65.9%; spontaneous bacterial peritonitis: 21.8% vs. 15.7%; hepatic encephalopathy: 41.0% vs. 25.0%; acute variceal bleeding: 32.0% vs. 23.7%; and acute kidney injury 30.5% vs. 19.6%. ALC patients had higher Child-Pugh (10.6±2.0 vs. 9.0±2.3), model for end-stage liver-disease scores (21.49±8.47 vs. 16.85±7.79), and higher mortality (42.3% vs. 27.3%, P<0.001) compared to non-ALC. Conclusions: One-third of cirrhosis patients die in index hospitalization. 60% of the survivors require at least one rehospitalization within a year. ALC patients present with higher morbidity and mortality and at a younger age.

Abstract

Background/Aims: Liver cirrhosis is an important cause of morbidity and mortality globally. Every episode of decompensation and hospitalization reduces survival. We studied the clinical profile and long-term outcomes comparing alcohol-related cirrhosis (ALC) and non-ALC. Methods: Cirrhosis patients at index hospitalisation (from January 2010 to June 2017), with ≥1 year follow-up were included. Results: Five thousand and one hundred thirty-eight cirrhosis patients (age, 49.8±14.6 years; male, 79.5%; alcohol, 39.5%; Child-A:B:C, 11.7%:41.6%:46.8%) from their index hospitalization were analysed. The median time from diagnosis of cirrhosis to index hospitalization was 2 years (0.2–10). One thousand and seven hundred seven patients (33.2%) died within a year; 1,248 (24.3%) during index hospitalization. 59.5% (2,316/3,890) of the survivors, required at least one readmission, with additional mortality of 19.8% (459/2,316). ALC compared to non-ALC were more often (P<0.001) male (97.7% vs. 67.7%), younger (40–50 group, 36.2% vs. 20.2%; P<0.001) with higher liver related complications at baseline, (P<0.001 for each), sepsis: 20.3% vs. 14.9%; ascites: 82.2% vs. 65.9%; spontaneous bacterial peritonitis: 21.8% vs. 15.7%; hepatic encephalopathy: 41.0% vs. 25.0%; acute variceal bleeding: 32.0% vs. 23.7%; and acute kidney injury 30.5% vs. 19.6%. ALC patients had higher Child-Pugh (10.6±2.0 vs. 9.0±2.3), model for end-stage liver-disease scores (21.49±8.47 vs. 16.85±7.79), and higher mortality (42.3% vs. 27.3%, P<0.001) compared to non-ALC. Conclusions: One-third of cirrhosis patients die in index hospitalization. 60% of the survivors require at least one rehospitalization within a year. ALC patients present with higher morbidity and mortality and at a younger age.

참고문헌 (32)

  1. "Global burden of liver disease: a true burden on health sciences and economies"[URL]
  2. Lim YS, "The global impact of hepatic fibrosis and endstage liver disease", Clin Liver Dis, 12, pp.733~746 (2008)
  3. Scaglione S, "The epidemiology of cirrhosis in the United States: a populationbased study", J Clin Gastroenterol, 49, pp.690~696 (2015)
  4. GBD 2017 Cirrhosis Collaborators, "The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017", Lancet Gastroenterol Hepatol, 5, pp.245~266 (2020)
  5. Mokdad AA, "Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis", BMC Med, 12, pp.145~ (2014)
  6. Zatoński WA, "Liver cirrhosis mortality in Europe, with special attention to Central and Eastern Europe", Eur Addict Res, 16, pp.193~201 (2010)
  7. Vergara M, "Hospital mortality over time in patients with specific complications of cirrhosis", Liver Int, 33, pp.828~833 (2013)
  8. Schmidt ML, "Decreasing mortality among patients hospitalized with cirrhosis in the United States from 2002 through 2010", Gastroenterology, 148, pp.967~977.e2 (2015)
  9. Rehm J, "Global burden of alcoholic liver diseases", J Hepatol, 59, pp.160~168 (2013)
  10. Junling Wang, "Diagnostic value of alcoholic liver disease (ALD)", nonalcoholic fatty liver disease (NAFLD) index combined with γ-glutamyl transferase in differentiating ALD and NAFLD, 2016, pp.31(3), 479~487[DOI]
  11. Adejumo AC, "Cannabis use is associated with reduced prevalence of progressive stages of alcoholic liver disease", Liver Int, 38, pp.1475~1486 (2018)
  12. Ray G, "Trends of chronic liver disease in a tertiary care referral hospital in Eastern India", Indian J Public Health, 58, pp.186~194 (2014)
  13. Wang WJ, "Growing burden of alcoholic liver disease in China: a review", World J Gastroenterol, 25, pp.1445~1456 (2019)
  14. Liangpunsakul S, "Alcoholic liver disease in Asia, Europe, and North America", Gastroenterology, 150, pp.1786~1797 (2016)
  15. Shah ND, "Alcohol-related liver disease is rarely detected at early stages compared with liver diseases of other etiologies worldwide", Clin Gastroenterol Hepatol, 17, pp.2320~2329.e12 (2019)
  16. Lefton HB, "Diagnosis and epidemiology of cirrhosis", Med Clin North Am, 93, pp.787~799 (2009)
  17. Ginès P, "Hepatorenal syndrome", Lancet, 362, pp.1819~1827 (2003)
  18. Mukherjee PS, "Etiology and mode of presentation of chronic liver diseases in India: a multi centric study", PLoS One, 12, pp.e0187033~ (2017)
  19. Singal AK, "Recent trends in the epidemiology of alcoholic liver disease", Clin Liver Dis (Hoboken), 2, pp.53~56 (2013)
  20. 김희언, "Complications Requiring Hospital Admission and Causes of In-Hospital Death over Time in Alcoholic and Nonalcoholic Cirrhosis Patients", Gut and Liver, 10(1), pp.95~100 (2016), 거트앤리버 소화기연관학회협의회
  21. Huang A, "Disease spectrum of alcoholic liver disease in Beijing 302 Hospital from 2002to 2013: a large tertiary referral hospital experience from 7422 patients", Medicine (Baltimore), 96, pp.e6163~ (2017)
  22. Bhattacharyya M, "Clinical profile of cirrhosis of liver in a tertiary care hospital of Assam, North East India", IOSR-JDMS, 15, pp.21~27 (2016)
  23. Pathak OK, "Retrospective study of the clinical profile and prognostic indicators in patients of alcoholic liver disease admitted to a tertiary care teaching hospital in Western Nepal", Saudi J Gastroenterol, 15, pp.171~175 (2009)
  24. Singh SP, "Socioeconomic impact of alcohol in patients with alcoholic liver disease in eastern India", Indian J Gastroenterol, 35, pp.419~424 (2016)
  25. Sarin SK, "Young v Adult cirrhotics: a prospective, comparative analysis of the clinical profile, natural course and survival", Gut, 29, pp.101~107 (1988)
  26. Butterworth RF, "Complications of cirrhosis III. Hepatic encephalopathy", J Hepatol, 32(1 Suppl), pp.171~180 (2000)
  27. Nusrat S, "Cirrhosis and its complications: evidence based treatment", World J Gastroenterol, 20, pp.5442~5460 (2014)
  28. Maskey R, "Clinical profile of patients with cirrhosis of liver in a tertiary care hospital, Dharan, Nepal", Nepal Med Coll J, 13, pp.115~118 (2011)
  29. Vicco MH, "In-hospital mortality risk factors in patients with ascites due to cirrhosis", Rev Assoc Med Bras, 61, pp.35~39 (2015)
  30. Ratib S, "Causes of death in people with liver cirrhosis in England compared with the general population: a population-based cohort study", Am J Gastroenterol, 110, pp.1149~1158 (2015)
  31. Tandon P, "Renal dysfunction is the most important independent predictor of mortality in cirrhotic patients with spontaneous bacterial peritonitis", Clin Gastroenterol Hepatol, 9, pp.260~265 (2011)
  32. Samuel B. Ho, "Changes in Hospital Admissions and Mortality for Complications of Cirrhosis: Implications for Clinicians and Health Systems", Gut and Liver, 10(1), pp.8~9 (2016), 거트앤리버 소화기연관학회협의회

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