Risk for death in patients with cirrhosis more than twice as high in low-income countries
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Key takeaways:
- Patients with cirrhosis in low-income countries died in the hospital at a rate of 22% compared with 8% in high-income countries.
- Within 30 days of discharge, mortality rates were 30% and 14%, respectively.
Patients hospitalized with cirrhosis in low- or middle-income countries had significantly higher risk for mortality compared with patients in high-income countries, according to research in Lancet Gastroenterology & Hepatology.
“Most cirrhosis research is focused on the global North or specific regions of the world and doesn’t account for differences in public health resources,” Jasmohan S. Bajaj, MD, professor of internal medicine at Virginia Commonwealth University School of Medicine and a physician at the Richmond Veterans Affairs Medical Center, said in a university press release. “Our work is one of the only prospective studies to analyze imbalances in cirrhosis mortality from a global perspective.”
In an observational cohort study, the CLEARED Consortium collected data from 3,884 patients (mean age, 55.9 years; 64.2% men) hospitalized with cirrhosis at 90 tertiary care centers in 25 countries. Of these, 36.4% of patients were from high-income countries (HICs), 45.2% from upper-middle-income countries (UMICs) and 18.4% from low-income (LIC) or lower-middle-income countries (LMICs).
Primary outcomes included death and liver transplantation while hospitalized or within 30 days after discharge. Researchers surveyed participating centers about availability of and access to diagnostics and treatment and compared outcomes by country-level income.
Of the initial cohort, 410 patients were lost to follow-up within 30 days after hospital discharge.
According to results, 7.8% of patients died while hospitalized in HICs compared with 10.4% in UMICs and 22.1% in LICs/LMICs. Within 30 days of discharge, 14.4%, 17.2% and 30.3% of patients died, respectively.
Compared with patients in HICs, the risk for death during hospitalization was higher in UMICs (adjusted OR = 2.14; 95% CI, 1.61-2.84) and LICs/LMICs (aOR = 2.54; 95% CI, 1.82-3.54), a trend also observed 30 days after discharge (aOR = 1.95; 95% CI, 1.44-2.65 and aOR = 1.84; 95% CI, 1.24-2.72, respectively).
“These results are very shocking and sobering,” Bajaj said in the release. “We did not anticipate such a wide disparity in cirrhosis mortality, but it shows that globally we are not on a level playing field when it comes to addressing advanced liver disease.”
Researchers further reported that 4.2% of patients in HICs received LT during hospitalization compared with 1.6% in UMICs (aOR = 0.41; 95% CI, 0.24-0.69 vs. HICs) and 2% in LICs/LMICs (aOR = 0.21; 95% CI, 0.1-0.41 vs. HICs). Similar results were reported 30 days after discharge, with 9.2% receiving LT in HICs compared with 4% in UMICs (aOR = 0.58; 95% CI, 0.39-0.85 vs. HICs) and 3.1% in LICs/LMICs (aOR = 0.21; 95% CI, 0.11-0.4 vs. HICs).
“This issue looks very daunting right now, especially given that chronic health issues that lead to liver disease, such as diabetes, obesity and alcohol use disorder, are globally on the rise,” Bajaj said. “However, there are several steps we can take to change our course and ultimately save more lives. The foundation stone for making this kind of meaningful change is first raising awareness of these issues and prioritizing disease prevention.”
Reference:
- Risk of death from liver disease is twice as high in lower-income countries, new research suggests. https://news.vcu.edu/article/2023/05/risk-of-death-from-liver-disease-is-twice-as-high-in-lower-income-countries-new-research. Published May 23, 2023. Accessed June 01, 2023.
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