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Cirrhosis often follows alcohol-related health care visits

The incidence of alcohol-related liver cirrhosis among patients identified as high-risk ranged from 7% to 16% after approximately a decade of heavy drinking, and many patients had health care contact for alcohol misuse prior to diagnosis, according to results from a recently published study.

“Preventive interventions targeting such high-risk individuals include the delivery of brief interventions or cognitive-behavioral therapies shown to be associated with decreased mortality,” Gro Askgaard, MD, PhD, from the Copenhagen University Hospital in Denmark, and colleagues wrote. “Should interventions be effective in the prevention of alcoholic liver cirrhosis in high-risk populations, there should be opportunities to reach the majority of patients prior to their diagnosis. Alcohol-related health care contacts before alcoholic liver cirrhosis diagnosis represent such an opportunity.”

To identify opportunities to prevent alcoholic liver cirrhosis in high-risk populations, Askgaard and colleagues conducted a systematic review and meta-analysis and identified 38 multinational studies that included patients with an “alcohol problem diagnosis” or were seeking treatment for alcohol-related problems. Their goal was to answer the following three questions:

• What is the incidence of alcoholic liver cirrhosis in alcohol-problem cohorts?
• How much alcohol do alcoholic liver cirrhosis patients consume? and
• To what extent did patients have alcohol-related health care contacts prior to diagnosis?

The incidence of alcohol-related cirrhosis among hospitalized patients was 6.9% (95% CI, 4.1-10) after 8 years of heavy drinking. Among those referred to an internal medicine department, the incidence was 16% (95% CI, 10-21) after 8 years to 12 years of follow-up. In patients seeking treatment for alcohol-related problems, the incidence was 1.7% (95% CI, 0.9-2.5) within 5 years, 6.2% (95% CI, 4-8) between 5 years and 10 years, and 4.6% (95% CI, 2.7-6.9) after 10 years.

After pooling data, the researchers found that 31% (95% CI, 12-50) of patients with alcohol-related cirrhosis drank less than 80 g of alcohol per day, 44% (95 %CI, 34-54) drank between 80 g and 160 g per day, and 45% (95% CI, 34-56) drank more than 110 g per day.

Regarding their third question, the researchers noted there were too few studies to perform a meta-analysis. However, they found one study that estimated 61% of 2,479 patients had a primary care contact in which harmful drinking was recorded prior to a diagnosis of alcohol-related cirrhosis and another study that showed 40% of 7,719 patients had one hospital contact prior to diagnosis.

“Together with plenty of evidence pointing to the huge mortality and morbidity associated with alcohol problems, the present systematic review underscores the need for increasing the treatment of patients with alcohol problems in health care settings,” Askgaard and colleagues wrote. “Treatments could include the implementation of brief interventions for heavy drinkers, and cognitive-behavioral therapies and pharmacological treatments for alcohol dependence.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.