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Alcoholic cirrhosis-related mortality declines among Danish

Mortality due to alcoholic cirrhosis among Danish residents in Denmark has declined over time, according to findings published in American Journal of Gastroenterology.

Thomas Deleuran, MD, of the department of hepatology and gastroenterology, Aarhus University Hospital, Denmark, and colleagues reviewed nationwide health care data from The Danish National Patient Registry to identify residents in Denmark diagnosed with alcoholic cirrhosis to determine mortality over different time periods.

“Alcohol is by far the most common etiology of cirrhosis in Denmark, responsible for 79% of cirrhosis cases,” the researchers wrote. “Given this background, we aimed to compare the mortality among all Danish alcoholic cirrhosis patients diagnosed over six consecutive 3-year periods: 1996–1998, 1999–2001, 2002–2004, 2005–2007, 2008–2010, and 2011–2013.”

Secondary endpoints of the study included evaluating time trends in factors associated with mortality among patients diagnosed with alcoholic cirrhosis, such as inpatient hospitalizations, use of esophagogastroduodenoscopy (EGD) and use of transjugular intrahepatic portosystemic shunt (TIPS).

The study comprised 22,734 patients (69% men; median age at diagnosis, 57 years). Using multivariate cox regression analysis, the adjusted mortality HR for patients diagnosed between 1999 and 2001 was 0.99 (95% CI, 0.92–1.06); 1 (95% CI, 0.94–1.08) between 2002 and 2004; 0.97 (95% CI, 0.9–1.04) between 2005 and 2007; 0.94 (95% CI, 0.88–1.01) between 2008 and 2010; and 0.84 (95% CI, 0.79–0.9) between 2011 and 2013, compared with those diagnosed between 1996 and 1998.

The number of newly diagnosed patients with alcoholic cirrhosis was highest between 2008 and 2010 (n = 4,366) compared with the 1996 to 1998 period (n = 3,139). Between 2011 and 2013, the number of cases decreased from the period 2008 to 2010 (n = 4,122).

“We found no reason to suspect that the decreasing mortality could be explained by changes in patient characteristics or by changes in healthcare utilization or alcohol intake after cirrhosis diagnosis,” the researchers wrote.

The number of hospitalizations for alcohol-related disorders during 1 year after diagnosis increased from 21% to 25% for those diagnosed between 2005 and 2007. However, it decreased to 23% for patients diagnosed with alcoholic cirrhosis between 2011 and 2013.

The rate of EGDs remained steady per year from 1999 through 2013. The cumulative risk for the use of TIPS increased from 0 between 1996 to 1988 to 1.8% between 2011 and 2013. In addition, the cumulative 1-year risk for liver transplantation increased, but did not exceed 0.5%.

“In recent years, mortality among Danish alcoholic cirrhosis patients has decreased … Our study adds to the evidence for an improving prognosis for cirrhosis patients in general, and progress in medical care is among the plausible causes for improvement,” the researchers concluded. – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.