Epidemiology of liver cirrhosis and associated complications: Current knowledge and future directions

Abstract

Cirrhosis causes a heavy global burden. In this review, we summarized up-to-date epidemiological features of cirrhosis and its complications. Recent epidemiological studies reported an increase in the prevalence of cirrhosis in 2017 compared to in 1990 in both men and women, with 5.2 million cases of cirrhosis and chronic liver disease occurring in 2017. Cirrhosis caused 1.48 million deaths in 2019, an increase of 8.1% compared to 2017. Disability-adjusted life-years due to cirrhosis ranked 16th among all diseases and 7th in people aged 50-74 years in 2019. The global burden of hepatitis B virus and hepatitis C virus-associated cirrhosis is decreasing, while the burden of cirrhosis due to alcohol and nonalcoholic fatty liver disease (NAFLD) is increasing rapidly. We described the current epidemiology of the major complications of cirrhosis, including ascites, variceal bleeding, hepatic encephalopathy, renal disorders, and infections. We also summarized the epidemiology of hepatocellular carcinoma in patients with cirrhosis. In the future, NAFLD-related cirrhosis will likely become more common due to the prevalence of metabolic diseases such as obesity and diabetes, and the prevalence of alcohol-induced cirrhosis is increasing. This altered epidemiology should be clinically noted, and relevant interventions should be undertaken.

Keywords: Burden; Causes; Cirrhosis; Complications; Cost; Epidemiology; Feature.

Figure 1

The latest epidemiological data on the major complications of liver cirrhosis. The prevalence of covert hepatic encephalopathy depends on the means of diagnosis, the stage of cirrhosis, the underestimation of HE, and the presence of other factors affecting the prevalence. For the prevalence of infections, these data were obtained from the Nationwide Readmissions Database; therefore, the total population included readmissions. SBP: Spontaneous bacterial peritonitis; CHE: Covert hepatic encephalopathy; OHE: Overt hepatic encephalopathy; AKI: Acute kidney injury; HRS: Hepatorenal syndrome; MDRO: Multidrug-resistant organisms.