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. 2022 Mar;10(2):198-211.
doi: 10.1002/ueg2.12200. Epub 2022 Jan 28.

Risk of infections and their role on subsequent mortality in biopsy-proven alcohol-related liver disease

Hannes Hagström  1   2   3 , Maja Thiele  4   5 , Tracey G Simon  6   7   8   9 , Rajani Sharma  10 , Anna Röckert Tjernberg  11 , Bjorn Roelstraete  6 , Jonas Söderling  6 , Jonas F Ludvigsson  6   12   13
Affiliations

Risk of infections and their role on subsequent mortality in biopsy-proven alcohol-related liver disease

Hannes Hagström et al. United European Gastroenterol J. 2022 Mar.

Abstract

Background and aims: The risk for infection in alcohol-related liver disease (ALD) has rarely been investigated at a population level, nor if the underlying liver histopathology is associated with infection risk. We examined the rate of hospital-based infections in a nationwide cohort of biopsy-proven ALD, and the subsequent risk of death.

Methods: Population-based cohort study in Sweden comparing 4028 individuals with an international classification of disease (ICD) code for ALD and a liver biopsy from 1969 to 2017 with 19,296 matched general population individuals. Swedish national registers were used to ascertain incident infections in secondary or tertiary care and subsequent mortality until 2019. We used Cox regression, adjusted for sex, age, education, country of birth, diabetes, and number of hospitalizations in the year preceding liver biopsy date, to estimate hazard ratios (HRs) in ALD and histopathological subgroups compared to reference individuals.

Results: Median age at ALD diagnosis was 59 years, 65% were men and 59% had cirrhosis at baseline. Infections were more common in patients with ALD (84 cases/1000 person-years [PY]) compared to reference individuals (29/1000 PYs; adjusted hazard ratio [aHR] 3.06, 95% CI = 2.85-3.29). This excess risk corresponded to one additional infection per 18 ALD patients each year. The rate of infections was particularly high in individuals with cirrhosis (aHR = 3.46) and in those with decompensation (aHR = 5.20). Restricting our data to those with an infection, ALD (aHR = 3.63, 95%CI = 3.36-3.93), and especially ALD cirrhosis (aHR = 4.31, 95%CI = 3.89-4.78) were linked to subsequent death.

Conclusions: Individuals with biopsy-proven ALD have a three-fold increased rate of infections compared with the general population. The risk of death after an infection is also considerably higher in individuals with ALD.

Keywords: alcoholic liver disease; cirrhosis; death; epidemiology; ethanol; infection; prognosis.

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Conflict of interest statement

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organization for the submitted work. Other conflict of interest are listed below. Hannes Hagström: consulting fees from Novo Nordisk and Gilead. Research grants to institution from Gilead, Astra Zeneca, Intercept, EchoSens, Pfizer, MSD. Advisory Board at Bristol‐Myers Squibb and Gilead. Unrelated to current work. Maja Thiele: Speaker's fee from EchoSens, Siemens Healthcare, Norgine. Consulting fee from GE Healthcare. Unrelated to current work. Jonas F Ludvigsson: coordinates a study on behalf of the Swedish IBD quality register (SWIBREG). This study has received funding from Janssen Corporation. Unrelated to current work. Rajani Sharma: Speaker for Takeda. Unrelated to current work. Jonas Söderling, Bjorn Roelstraete, Tracey G Simon, Anna Röckert Tjernberg: nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Cumulative incidence curves of time to any infection in patients with alcohol‐related liver disease (ALD) and matched reference individuals from the general population
FIGURE 2
FIGURE 2
Kaplan‐Meier failure curves for time to all‐cause mortality from time of infection in patients with alcohol‐related liver disease (ALD) and matched reference individuals, with an infection, from the general population
See this image and copyright information in PMC

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