Mortality in biopsy-proven alcohol-related liver disease: a population-based nationwide cohort study of 3453 patients

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Hagström, HannesKarolinska Institutet (author)

Mortality in biopsy-proven alcohol-related liver disease : a population-based nationwide cohort study of 3453 patients

Article/chapterEnglish2021

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2020-03-27
BMJ Publishing Group Ltd,2021
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LIBRIS-ID:oai:DiVA.org:oru-89721
https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-89721URI
https://doi.org/10.1136/gutjnl-2019-320446DOI
http://kipublications.ki.se/Default.aspx?queryparsed=id:145753988URI

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Language:English
Summary in:English

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Objective: Patients with alcohol-related liver disease (ALD) are at increased risk of death, but studies have rarely investigated the significance of histological severity or estimated relative risks compared with a general population. We examined mortality in a nationwide cohort of biopsy-proven ALD.Design: Population-based cohort study in Sweden comparing 3453 individuals with an International Classification of Disease (ICD) code for ALD and a liver biopsy from 1969 to 2017 with 16 535 matched general population individuals. Swedish national registers were used to ascertain overall and disease-specific mortality, starting follow-up at the latest of first ICD diagnosis or liver biopsy plus 3 months. Cox regression adjusted for relevant confounders was used to estimate HRs in ALD and histopathological subgroups.Results: Median age at diagnosis was 58 years, 65% were men and 52% had cirrhosis at baseline. Five-year cumulative mortality was 40.9% in patients with ALD compared with 5.8% in reference individuals. The risk for overall mortality was significantly increased (adjusted HR (aHR)=4.70, 95% CI 4.35 to 5.08). The risk of liver-related death was particularly high (43% of all deaths, aHR=167.6, 95% CI 101.7 to 276.3). Mortality was significantly increased also in patients with ALD without cirrhosis and was highest in the first year after baseline but persisted after >= 10 years of follow-up (aHR=2.74, 95% CI 2.37 to 3.16).Conclusion: Individuals with biopsy-proven ALD have a near fivefold increased risk of death compared with the general population. Individuals with ALD without cirrhosis were also at increased risk of death, reaffirming the need to increase vigilance in the management of these individuals.

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Thiele, MajaDepartment of Gastroenterology and Hepatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark (author)
Roelstraete, BjornKarolinska Institutet (author)
Söderling, JonasKarolinska Institutet (author)
Ludvigsson, Jonas F.,1969-Karolinska Institutet,Örebro universitet,Institutionen för medicinska vetenskaper,Region Örebro län,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK; Department of Medicine, Columbia University College of Physicians and Surgeons, New York City NY, USA(Swepub:oru)jsln (author)
Karolinska InstitutetDepartment of Gastroenterology and Hepatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark (creator_code:org_t)

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In:Gut: BMJ Publishing Group Ltd70:1, s. 170-1790017-57491468-3288

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By the author/editor: Hagström, Hannes; Thiele, Maja; Roelstraete, Bjo ...; Söderling, Jonas; Ludvigsson, Jona ...

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Gastroenterology ...

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