Alcohol associated liver cirrhotics have higher mortality after index hospitalization: Long-term data of 5,138 patients

Abstract

Background/aims: Liver cirrhosis is an important cause of morbidity and mortality globally. Every episode of decompensation and hospitalization reduces survival. We studied the clinical profile and long-term outcomes comparing alcohol-related cirrhosis (ALC) and non-ALC.

Methods: Cirrhosis patients at index hospitalisation (from January 2010 to June 2017), with ≥1 year follow-up were included.

Results: Five thousand and one hundred thirty-eight cirrhosis patients (age, 49.8±14.6 years; male, 79.5%; alcohol, 39.5%; Child-A:B:C, 11.7%:41.6%:46.8%) from their index hospitalization were analysed. The median time from diagnosis of cirrhosis to index hospitalization was 2 years (0.2-10). One thousand and seven hundred seven patients (33.2%) died within a year; 1,248 (24.3%) during index hospitalization. 59.5% (2,316/3,890) of the survivors, required at least one readmission, with additional mortality of 19.8% (459/2,316). ALC compared to non-ALC were more often (P<0.001) male (97.7% vs. 67.7%), younger (40-50 group, 36.2% vs. 20.2%; P<0.001) with higher liver related complications at baseline, (P<0.001 for each), sepsis: 20.3% vs. 14.9%; ascites: 82.2% vs. 65.9%; spontaneous bacterial peritonitis: 21.8% vs. 15.7%; hepatic encephalopathy: 41.0% vs. 25.0%; acute variceal bleeding: 32.0% vs. 23.7%; and acute kidney injury 30.5% vs. 19.6%. ALC patients had higher Child-Pugh (10.6±2.0 vs. 9.0±2.3), model for end-stage liver-disease scores (21.49±8.47 vs. 16.85±7.79), and higher mortality (42.3% vs. 27.3%, P<0.001) compared to non-ALC.

Conclusion: One-third of cirrhosis patients die in index hospitalization. 60% of the survivors require at least one rehospitalization within a year. ALC patients present with higher morbidity and mortality and at a younger age.

Keywords: Ascites; Bleeding; Cirrhosis; Morbidity; Mortality.

Figure 1.

Flow chart showing the inclusion of cirrhotic patients with index hospitalization. CKD, chronic kidney disease; ALF, acute liver failure.

Figure 2.

(A) Change in 1-year mortality due to alcoholic liver disease correlates with the number of alcohol patients (percentage) over time. Bars show the number of alcohol vs. non-alcohol patients (left %-Y axis), and line shows patient death, alcohol vs. non-alcohol (right %-Y axis). Label displayed only alcohol died percentage. As the alcohol cases increases their corresponding died cases also increases. (B) Change in mean model for end-stage liver disease (MELD) with the alcohol vs. non-alcohol cirrhosis patients over time. Bars shows patients with alcohol vs. non-alcohol (left %-Y axis), however, line shows mean MELD value of alcohol vs. non-alcohol (right mean value-Y axis). Line shows that alcohol patients had high mean MELD score.

Figure 3.

(A) The distribution by type and number of complications at baseline and its association with MELD score. Bars show types of complication (left %-Y axis) and line shows mean MELD (right mean MELD-Y axis). As the number of complications (1, 2, 3, 4, 5) increased, the mean MELD score increased correspondingly. (B) The etiologies assessed were alcohol vs. others. Kaplan Meier survival curve shows 1 year survival between ALC (56.9%) vs. non-ALC (71.9%). HRS, hepatorenal syndrome; SBP, spontaneous bacterial peritonitis; AVB, acute variceal bleeding; HE, hepatic encephalopathy; MELD, model for end-stage liver disease; ALC, alcohol related cirrhosis.