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Patients with alcoholic cirrhosis at high risk of liver-related death

Adults in England with alcoholic cirrhosis had a high risk of liver-related mortality compared with other patient populations and the general population, according to study findings.

“[In the United Kingdom], mortality in people with cirrhosis is high, with 5-year survival rates reported to be similar to that of bowel cancer,” the researchers wrote. “However, contemporary knowledge of what people with cirrhosis die from and how this varies by etiology of their cirrhosis is lacking. Such information can be important to demonstrate areas where premature mortality could be reduced and guide evidence-based practice in patient follow-up.”

The researchers analyzed data of 5,118 adults with liver cirrhosis from the linked Clinical Practice Research Datalink and English Hospital Episode Statistics databases, which were also linked to the Office for National Statistics, between 1998 and 2009. These patients were matched according to age to 152,903 healthy controls from the general population. They examined the data and calculated the cumulative incidence, while adjusting for competing risks, and excess risk of mortality 5 years from diagnosis of liver cirrhosis, in an effort to determine different causes of mortality by etiology and stage of disease. The median follow-up was 1.88 years for patients with liver cirrhosis and 3.13 years for those without liver cirrhosis.

Among compensated patients, the 5-year excess risk of liver-related mortality was higher compared with any other cause of death for all patients, except those of unspecified etiology, according to the researchers. Patients with alcohol etiology had a 30.8% excess risk of liver-related mortality compared with 9.9% excess risk among patients with non–liver-related mortality. However, patients of unspecified etiology had a higher excess risk of non–liver-related mortality compared with liver-related mortality (10.7 vs. 6.7%).

“This was due to a high excess risk of non-liver neoplasm death,” the researchers wrote.

The researchers added that all patients with decompensated cirrhosis had the highest excess of liver-related mortality than any other cause.

In a subgroup analysis of smokers and non-smokers, in compensated patients, the highest excess of non-liver neoplasm death was seen in patients of unspecified etiology in both patients who smoked (9.24%) and non-smokers (5.87%).

“Predicting future mortality rates is important, as such knowledge may enable improved planning of health services and prioritization of limited public health resources,” the researchers wrote.

The researchers concluded: “In order to reduce premature mortality among people with liver cirrhosis, patients’ care pathways need to be tailored depending on the etiology and the stage of disease.” – by Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.