Former Smash Mouth singer’s death underscores need for liver disease awareness
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After nearly a decade of health problems, Steve Harwell, former lead singer and frontman for the band Smash Mouth, died Sept. 4 at age 56, which the band’s manager, Robert Hayes, said was caused by acute liver failure.
"His only tools were his irrepressible charm and charisma, his fearlessly reckless ambition,” Hayes said in a statement released to several news outlets. “Steve lived a 100% full-throttle life. Burning brightly across the universe before burning out.”
In 2013, Harwell was diagnosed with cardiomyopathy and Wernicke encephalopathy, an acute neurological condition that affected his memory and speech. He retired from Smash Mouth in 2021, citing “physical and mental health issues.”
According to the American Liver Foundation, 4.5 million U.S. adults have been diagnosed with liver disease which, if left untreated, can lead to liver failure and liver cancer. In 2020, 51,642 adults in the U.S. died from liver disease, and chronic liver disease or cirrhosis was the 12th leading cause of death.
Harwell’s death underscores the need for heightened awareness about common risk factors for liver disease, such as alcohol abuse, hepatitis C and steatohepatitis.
Keep reading for additional Healio coverage on liver-related care, including updated ACG guidelines, racial disparities in liver transplantation, Naltrexone use among those with alcohol use disorder and novel research from EASL Congress.
New ACG guideline highlights treatment, transplant considerations for acute liver failure
The ACG has created a new clinical guideline based on existing data and expert opinion to aid clinicians in the diagnosis and management of patients with acute liver failure, with a focus on specific etiologies and disease presentation.
“Acute liver failure (ALF) is a life-threatening condition that occurs in patients with no preexisting liver disease and is characterized by liver injury, coagulopathy and hepatic encephalopathy,” Alexandra Shingina, MD, MSc, assistant professor of medicine in the division of gastroenterology, hepatology and nutrition at Vanderbilt University Medical Center, and colleagues wrote in the American Journal of Gastroenterology. “It has a multitude of etiologies and a variety of clinical presentations that can affect virtually every organ system. It is imperative for clinicians to recognize ALF early in patient presentation because initiation of treatment and transplant considerations could be lifesaving.” Read more.
Despite narrowing the gap, racial disparities persist in liver transplantation, mortality
Disparities in receipt of liver transplantation and mortality persisted over time among hospitalized Black and Hispanic patients with decompensated cirrhosis compared with their white counterparts, according to data in JAMA Network Open.
“There had been no characterization of disparities in receipt of inpatient procedures for cirrhosis in over a decade,” Lauren D. Nephew, MD, MSCE, assistant professor of gastroenterology and hepatology and associate vice chair of health equity at Indiana University School of Medicine, told Healio. “Yet, there have been significant changes in the epidemiology of liver disease, efforts to improve cirrhosis care quality and policy changes, like Medicaid expansions to help improve access to care.” Read more.
Naltrexone achieves abstinence, reduces lapses in patients with alcohol use disorder
Naltrexone was effective in achieving abstinence, reducing lapses and improving craving scores at 3 months in patients with alcohol-related cirrhosis, according to data presented at EASL Congress.
“In the largest randomized controlled trial available to date, which is a combined trial with 1,380 patients with alcohol use disorder, naltrexone has been shown to have an increased incidence of abstinence and also reduced heavy drinking days,” Manasa Alla, MD, of the Institute of Liver and Biliary Sciences in New Delhi, said. Read more.
Risk for alcohol-related hospitalization fourfold higher in offspring of parents with ALD
Children of parents with alcohol-related liver disease had up to a more than fourfold increased risk for alcohol-related hospitalization, despite a low absolute risk for developing alcohol-related liver disease.
“Patients with alcohol-related liver disease have on average been drinking heavily for 10 to 20 years before they are diagnosed, in which time they might raise children,” Gro Askgaard, MD, a clinical researcher in the department of hepatology and gastroenterology at Aarhus University Hospital in Denmark, said at EASL Congress. “Being exposed to parental alcohol abuse may increase the risk of alcohol abuse disorder for these offspring. In addition, these offspring may also have a genetic susceptibility to develop alcohol-related liver disease if they drink hazardously.” Read more.
Only 25% of patients with cirrhosis receive transplant referrals at safety-net hospitals
Nearly 75% of patients with end-stage liver disease in safety-net hospitals were not referred for liver transplant evaluation, mostly due to active alcohol use or insurance issues, according to data published in JAMA Network Open.
“Patients with cirrhosis treated at safety-net hospitals have high mortality,” Mignote Yilma, MD, of the department of general surgery at the University of California, San Francisco, and colleagues wrote. “Most current studies focus on identifying factors associated with LT once a patient is referred for evaluation, rather than referral rates among the eligible population with end-stage liver disease, where significant drop-offs are anticipated.” Read more.
Nearly 15% of patients with alcohol-related liver disease progress to decompensation
Among patients with alcoholic-related liver disease in early stages, 15% progressed to decompensation and 22% died within 6 years, according to data presented at EASL Congress.
“Despite [alcohol-related liver disease] being highly prevalent, it is still largely under studied and overlooked as a research area,” Stine Johansen, MBBS, from the Odense University Hospital in Denmark, told attendees. “It is important to study the natural history of disease, as this information will help us improve diagnostic and treatment strategies and also help inform public health strategies and guidelines.” Read more.
One-fifth of NASH patients develop cirrhosis in 4 years; lower risk for women, nonsmokers
Among patients with nonalcoholic steatohepatitis in the United States, 20% progressed to cirrhosis within 4 years, with female sex and nonsmoking status linked to lower risk for progression, according to data from the TARGET-NASH trial.
“One of the challenges is understanding what the progression rate is in the real world — and by real world I mean outside of the tertiary liver centers, where perhaps there is a selection bias for patients,” Philip Newsome, MD, PhD, professor of hepatology at the University of Birmingham, said during a presentation at EASL Congress. “The purpose of this [study] was to try to better understand the natural history of [NASH] in the United States and identify factors that may be associated with progression.” Read more.
Use of simvastatin plus rifaximin not supported in patients with decompensated cirrhosis
Simvastatin plus rifaximin did not reduce progression to acute-on-chronic liver failure, complications from cirrhosis or risk for death in patients with decompensated cirrhosis, according to data presented at EASL Congress.
“Rifaximin prevents recurrent hepatic encephalopathy; however, it is not known whether it may have beneficial effects on other complications of cirrhosis,” Elisa Pose, MD, PhD, of the Liver Unit at the Clinical Hospital of Barcelona, said. “The effects of the combination of statins and rifaximin on the natural history of decompensated cirrhosis have not been investigated.” Read more.
References:
- How many people have liver disease? https://liverfoundation.org/about-your-liver/facts-about-liver-disease/how-many-people-have-liver-disease/. Accessed Sept. 5, 2023.
- Smash Mouth’s Steve Harwell retires, citing ‘physical and mental health issues.’ https://www.latimes.com/entertainment-arts/music/story/2021-10-12/smash-mouth-steve-harwell-retires-concert-video. Published Oct. 21, 2021. Accessed Sept. 4, 2023.
- Steve Harwell, former Smash Mouth singer, dies at 56: 'A 100% full-throttle life.’ https://www.usatoday.com/story/entertainment/music/2023/09/04/steve-harwell-dies-smash-mouth-singer-hospice/70760769007/. Published Sept. 4, 2023. Accessed Sept. 5, 2023.
- Steve Harwell, the former lead singer of Smash Mouth, has died at 56. https://www.npr.org/2023/09/04/1197540017/smash-mouth-steve-harwell-dies. Published Sept. 4, 2023. Accessed Sept. 5, 2023.
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