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Hospital patients with alcohol problems 10 times as likely to have alcoholic liver cirrhosis

Hospitalized patients who have alcohol problems had a significantly greater risk for developing alcoholic liver cirrhosis compared with the general population, according to the results of a Danish nationwide, registry-based, prospective cohort study.

“We studied the 15-year risk for alcoholic liver cirrhosis in hospital patients with obvious alcohol problems (a diagnosis of alcohol intoxication, harmful alcohol use, or alcohol dependence),” Gro Askgaard, MD, of the department of hepatology, Copenhagen University Hospital, told Healio.com/Hepatology. “They had a more than a 10-fold greater rate of alcoholic liver cirrhosis compared to the general Danish population. The risk was greatest (8% to 10%) for alcoholic liver cirrhosis within 15 years for patients [aged] 40-59 years and for patients diagnosed with harmful use or dependence.”

Gro Askgaard

Askgaard and colleagues evaluated all Danish patients with alcohol problems identified at an initial hospital contact between 1998 and 2002 (n = 36,044; two-thirds men), and followed them for the development of alcoholic liver cirrhosis up to 2014. They estimated the incidence rate of alcoholic liver cirrhosis in these patients relative to the general population, and identified predictors of the absolute risk for alcoholic liver cirrhosis.

Similar proportions of patients were diagnosed with alcohol intoxication or dependence (37% to 42%) and 20% to 21% were diagnosed with harmful alcohol use. After 411,417 person-years of follow-up, 1,406 men and 560 women were diagnosed with alcoholic liver cirrhosis.

The investigators found that patients in their 20s, 30s and 60s and those aged older than 70 years had a lower 15-year risk for alcoholic liver cirrhosis compared with patients in their 40s. Moreover, they found that patients who were diagnosed with harmful alcohol use or dependence had a higher 15-year risk for alcoholic liver cirrhosis compared with patients who were diagnosed with alcohol intoxication.

In men, the 15-year absolute risk for developing alcoholic liver cirrhosis was 0.7% for those aged 20-29 years, 5.5% for those in their 30s, 9.8% for those in their 40s, 8.9% for those in their 50s, 6.2% for those in their 60s, and 2.5% for those aged 70 and older. Also among men, the 15-year absolute risk was 2.6% for those diagnosed with alcohol intoxication, 7.7% for those diagnosed with harmful alcohol use, and 8.8% for those diagnosed with alcohol dependence.

Civil status, education and type of hospital care were not predictive of alcoholic liver cirrhosis.

“The absolute risks for alcoholic liver cirrhosis were slightly higher in men compared to women,” the investigators wrote.

The overall absolute risks at 5, 10 and 15 years were 2.6%, 4.5% and 5.9% in men, respectively, compared with 2.3%, 4% and 5.1% in women.

The incidence rate ratio for alcoholic liver cirrhosis was 11 (95% CI, 10-12) in men and 18 (95% CI, 15-21) in women compared with the general population.

Lack of data on lifestyle factors like smoking and obesity, which can influence the risk for alcoholic liver cirrhosis in heavy drinkers, was a study limitation, the researchers noted.

“Together with other evidence, our study indicates a need for the presence of alcohol care teams in the hospital setting,” Askgaard said. “Moreover, non-invasive serum biomarker tests and transient elastography that can detect early stages of liver disease could be relevant to offer middle-aged patients with alcohol problems.” – by Adam Leitenberger

Disclosures: The researchers report no relevant financial disclosures.