Changes in Characteristics of Patients with Liver Cirrhosis Visiting a Tertiary Hospital over 15 Years: a Retrospective Multi-Center Study in Korea

Abstract

Background: Liver cirrhosis has become a heavy burden not only for patients, but also for our society. However, little is known about the recent changes in clinical outcomes and characteristics of patients with cirrhosis-related complications in Korea. Therefore, we aimed to evaluate changes in characteristics of patients with liver cirrhosis in Daegu-Gyeongbuk province in Korea over the past 15 years. Methods: We retrospectively reviewed the medical records of 15,716 liver cirrhotic patients from 5 university hospitals in Daegu-Gyeongbuk province from 2000 to 2014. The Korean Standard Classification of Diseases-6 code associated with cirrhosis was investigated through medical records and classified according to the year of first visit. Results: A total of 15,716 patients was diagnosed with cirrhosis. A number of patients newly diagnosed with cirrhosis has decreased each year. In 2000, patients were most likely to be diagnosed with hepatitis B virus (HBV) cirrhosis, followed by alcoholic cirrhosis. There was a significant decrease in HBV (P < 0.001), but alcohol, hepatitis C virus (HCV), and nonalcoholic fatty liver disease (NAFLD) showed a significant increase during the study period (alcohol, P = 0.036; HCV, P = 0.001; NAFLD, P = 0.001). At the time of initial diagnosis, the ratio of Child-Turcotte-Pugh (CTP) class A gradually increased from 23.1% to 32.9% (P < 0.001). The most common cause of liver-related hospitalization in 2000 was hepatocellular carcinoma (HCC) (25.5%); in 2014, gastrointestinal bleeding with esophageal and gastric varices (21.4%) was the most common cause. Cases of hospitalization with liver-related complication represented 76.4% of all cases in 2000 but 70.9% in 2014. Incidence rate of HCC has recently increased. In addition, HCC-free survival was significantly lower in CTP class A than in classes B and C. Finally, there was significant difference in HCC occurrence according to causes (P < 0.001). HBV and HCV cirrhosis had lower HCC-free survival than alcoholic and NAFLD cirrhosis. Conclusion: In recent years, the overall number of cirrhosis patients has decreased. This study confirmed the recent trend in decrease of cirrhosis, especially of cirrhosis due to HBV, and the increase of HCV, alcoholic and NAFLD cirrhosis. Targeted screening for at-risk

Analysis of Complications and Risk Factors Other than Bleeding before and after Endoscopic Treatment of Esophagogastric Variceal Bleeding in Patients with Liver Cirrhosis

“…A total of 171 cases did not present COTB in cirrhosis at the time of admission, but bleeding symptoms were prevalent during the follow-up ( Table 1 ), which was consistent with the main complications of cirrhosis described in the Chinese textbook such as bleeding esophageal varices, cholelithiasis, infection, liver encephalopathy, and PVT or spongiform changes. Notably, other studies have reported a wide variety of complications in liver cirrhosis patients, which might be attributed to the different races and geographical locations of the study populations [ 2 , 26 , 27 ]. The three major complications occurring before and after the bleeding treatments were consistent, suggesting that bleeding treatment did not affect these complications.…”

“…Notably, the incidence rate of viral hepatitis-induced liver cirrhosis is significantly higher in the Chinese population than that in Western countries. Undoubtedly, liver cirrhosis has become one of the leading public health issues globally [ 2 ]. Although an early stage of liver cirrhosis can be cured, however, the later stage of the disease can lead to a spectrum of secondary complications, including progressive portal hypertension, systemic inflammation, liver failure, liver encephalopathy, and primary liver cancer [ 3 ], resulting in poor treatment outcomes [ 4 ].…”

The Change in Metabolic Syndrome Status and the Risk of Nonviral Liver Cirrhosis

“…Easy access to healthcare through universal health coverage, availability of a national health examination, which includes AST/ALT and GGT [ 39 ], and a national liver cancer surveillance program might increase the chances of detecting clinically significant LC. In addition, the definition of LC according to ICD 10 codes has been accepted as sufficiently reliable and has been used in previous studies [ 22 , 40 ], although external validation with clinical data has not been conducted. Finally, there may be a recall bias and impreciseness regarding the self-reported questionnaire.…”

Global epidemiology of cirrhosis — aetiology, trends and predictions

“…The proportion of cirrhosis cases due to HCV and HBV infection declined (from 59% to 40% and from 14% to 9%, respectively), although these remained the largest contributors. In another study in 15,716 patients with cirrhosis at five university hospitals in South Korea between 2000 and 2014, the proportion of cirrhosis cases due to NAFLD, alcohol consumption and HCV infection increased over the study period 57 . However, the study periods of both of these studies were before the widespread availability of DAA therapy for HCV infection, which is likely to reduce the proportion of cirrhosis cases that are due to HCV infection over time.…”