Study of liver cirrhosis over ten consecutive years in Southern China

Abstract

Aim: To investigate the etiology and complications of liver cirrhosis (LC) in Southern China.

Methods: In this retrospective, cross-sectional study, we identified cases of liver cirrhosis admitted between January 2001 to December 2010 and reviewed the medical records. Patient demographics, etiologies and complications were collected, and etiological changes were illustrated by consecutive years and within two time periods (2001-2005 and 2006-2010). All results were expressed as the mean ± SD or as a percentage. The χ(2) test or Student's t-test was used to analyze the differences in age, gender, and etiological distribution, and one-way analysis of variance was applied to estimate the trends in etiological changes. We analyzed the relationship between the etiologies and complications using unconditioned logistic regression, and the risk of upper gastrointestinal bleeding (UGIB) and hepatocellular carcinoma (HCC) in the major etiological groups was evaluated as ORs. A P value less than 0.05 was considered significant. Statistical computation was performed using SPSS 17.0 software.

Results: In this study, we identified 6719 (83.16%) male patients and 1361 (16.84%) female patients. The average age of all of the patients was 50.5 years at the time of diagnosis. The distribution of etiological agents was as follows: viral hepatitis, 80.62% [hepatitis B virus (HBV) 77.22%, hepatitis C virus (HCV) 2.80%, (HBV + HCV) 0.58%]; alcohol, 5.68%; mixed etiology, 4.95%; cryptogenic, 2.93%; and autoimmune hepatitis, 2.03%; whereas the other included etiologies accounted for less than 4% of the total. Infantile hepatitis syndrome LC patients were the youngest (2.5 years of age), followed by the metabolic LC group (27.2 years of age). Viral hepatitis, alcohol, and mixed etiology were more prevalent in the male group, whereas autoimmune diseases, cryptogenic cirrhosis, and metabolic diseases were more prevalent in the female group. When comparing the etiological distribution in 2001-2005 with that in 2006-2010, the proportion of viral hepatitis decreased from 84.7% to 78.3% (P < 0.001), and the proportion of HBV-induced LC also decreased from 81.9% to 74.6% (P < 0.001). The incidence of mixed etiology, cryptogenic cirrhosis, and autoimmune diseases increased by 3.1% (P < 0.001), 0.5% (P = 0.158), and 1.3% (P < 0.001), respectively. Alcohol-induced LC remained relatively steady over the 10-year period. The ORs of the development of UGIB between HBV and other major etiologies were as follows: HCV, 1.07; alcohol, 1.89; autoimmune, 0.90; mixed etiology, 0.83; and cryptogenic, 1.76. The ORs of the occurrence of HCC between HBV and other major etiologies were as follows: HCV, 0.54; alcohol, 0.16; autoimmune, 0.05; mixed etiology, 0.58; and cryptogenic, 0.60.

Conclusion: The major etiology of liver cirrhosis in Southern China is viral hepatitis. However, the proportions of viral hepatitis and HBV are gradually decreasing. Alcoholic LC patients exhibit a greater risk of experiencing UGIB, and HBV LC patients may have a greater risk of HCC.

Keywords: Complication; Epidemiology; Etiology; Hepatocellular carcinoma; Liver cirrhosis; Southern China.

Figure 1

Demographic characteristics of the 8080 enrolled liver cirrhosis patients. Age distribution of the liver cirrhosis patients is delineated as a population pyramid depending on gender, and 93.5% of male patients and 89.7% of female patients are between 30-74 years old. Male cases are presented as red bars, and female cases are presented as yellow bars.

Figure 2

Changing trends in the proportion of major etiologies over 10 consecutive years. The proportion of viral hepatitis-induced liver cirrhosis (LC) has decreased gradually in the past 10 years and that of alcoholic, mixed etiology, autoimmune and cryptogenic-induced LC have increased to some extent. Every marker illustrates the proportion of LC due to a different cause, and the changing trend is simulated by lining up the markers for each etiology as different colored lines. Viral hepatitis: LC caused by viral hepatitis, P < 0.001 in 10 years comparison; Alcohol: LC caused by alcohol consumption, P = 0.919 in 10 years comparison; Mixed etiology: LC caused by mixed etiology, P < 0.001 in 10 years comparison; Autoimmune: LC caused by autoimmune diseases, P < 0.001 in 10 years comparison; Cryptogenic: LC of unknown reason, P = 0.011 in 10 years comparison.

Figure 3

Changing trends in the proportion of subgroups of viral hepatitis over 10 consecutive years. The proportion of HBV-induced LC has decreased gradually over the 10 years, and those of HCV- and (HBV + HCV)-induced LC have not exhibited explicit trends. Every marker illustrates the proportion of LC due to a different cause, and the changing trend is simulated by lining up the markers for each etiology as different colored lines. HBV: LC caused by hepatitis B virus, P < 0.001 in 10 years comparison; HCV: LC caused by hepatitis C virus, P = 0.263 in 10 years comparison; HBV + HCV: LC caused by hepatitis B virus combined with hepatitis C virus, P = 0.267 in 10 years comparison. LC: Liver cirrhosis; HBV: Hepatitis B virus; HCV: Hepatitis C virus.