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. 2023 Oct 12;7(11):e0238.
doi: 10.1097/HC9.0000000000000238. eCollection 2023 Nov 1.

Risk of injuries before and after a diagnosis of cirrhosis: A population-based cohort study

Ying Shang  1 , Qing Shen  2   3 , Elliot B Tapper  4 , Axel Wester  1 , Hannes Hagström  1   5
Affiliations

Risk of injuries before and after a diagnosis of cirrhosis: A population-based cohort study

Ying Shang et al. Hepatol Commun. .

Abstract

Background: Cirrhosis is often asymptomatic prior to decompensation. Still, cognitive impairment and sarcopenia may be present before decompensation, possibly increasing the risk of injuries. We estimated the risk of injuries during the period shortly before and after cirrhosis diagnosis.

Methods: All patients (N=59,329) with a diagnosis of cirrhosis from 1997 to 2019 were identified from the Swedish National Patient Register. We used a self-controlled case series design to compare the incidence rates (IR) of injuries during a "diagnostic period" (within 3 months before or after the cirrhosis diagnosis date) to a self-controlled "prediagnostic period" (the same 6 calendar months 3 years before diagnosis), using conditional Poisson regression. Injuries were ascertained from the National Patient Register.

Results: We identified 23,733 (40.0%) patients with compensated and 35,595 (60.0%) with decompensated cirrhosis. There were 975 injuries (IR 2.8/1000 person-months) during the prediagnostic period, and 3610 injuries (IR 11.6/1000 person-months) identified during the diagnostic period. The IR ratio was 8.1 (95% CI 7.5-8.7) comparing the diagnostic period with the prediagnostic period. For patients with compensated cirrhosis, the risk increment of injuries was highest just before the diagnosis of cirrhosis, whereas the risk increase was highest shortly after the diagnosis for those with decompensation.

Conclusions: The incidence of injuries increases shortly before and after the diagnosis of cirrhosis. These findings indicate that cirrhosis is frequently diagnosed in conjunction with an injury, and highlight the need for injury prevention after cirrhosis diagnosis, especially in patients with decompensation.

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Conflict of interest statement

Hannes Hagström received grants from AstraZeneca, Echosens, Pfizer, MSD, Intercept, and Gilead. The remaining authors have no conflicts to report.

Figures

FIGURE 1
FIGURE 1
Overview of the study design.
FIGURE 2
FIGURE 2
Incidence rate ratio of injuries during diagnostic period compared to prediagnostic period in compensated cirrhosis (A), decompensated cirrhosis (B), alcohol-associated cirrhosis (C), and compensated cirrhosis due to other etiologies (D).
See this image and copyright information in PMC

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