Comorbidities and Outcome of Alcoholic and Non-Alcoholic Liver Cirrhosis in Taiwan: A Population-Based Study

Abstract

The prognosis of different etiologies of liver cirrhosis (LC) is not well understood. Previous studies performed on alcoholic LC-dominated cohorts have demonstrated a few conflicting results. We aimed to compare the outcome and the effect of comorbidities on survival between alcoholic and non-alcoholic LC in a viral hepatitis-dominated LC cohort. We identified newly diagnosed alcoholic and non-alcoholic LC patients, aged ≥40 years old, between 2006 and 2011, by using the Longitudinal Health Insurance Database. The hazard ratios (HRs) were calculated using the Cox proportional hazards model and the Kaplan–Meier method. A total of 472 alcoholic LC and 4313 non-alcoholic LC patients were identified in our study cohort. We found that alcoholic LC patients were predominantly male (94.7% of alcoholic LC and 62.6% of non-alcoholic LC patients were male) and younger (78.8% of alcoholic LC and 37.4% of non-alcoholic LC patients were less than 60 years old) compared with non-alcoholic LC patients. Non-alcoholic LC patients had a higher rate of concomitant comorbidities than alcoholic LC patients (79.6% vs. 68.6%, p < 0.001). LC patients with chronic kidney disease demonstrated the highest adjusted HRs of 2.762 in alcoholic LC and 1.751 in non-alcoholic LC (all p < 0.001). In contrast, LC patients with hypertension and hyperlipidemia had a decreased risk of mortality. The six-year survival rates showed no difference between both study groups (p = 0.312). In conclusion, alcoholic LC patients were younger and had lower rates of concomitant comorbidities compared with non-alcoholic LC patients. However, all-cause mortality was not different between alcoholic and non-alcoholic LC patients.

Impact of metabolic risk factors on hepatic and cardiac outcomes in patients with alcohol- and non-alcohol-related fatty liver disease

“…Given that most patients with FLD also have either NAFLD or AFLD, it is important to separate the analyses to identify the effects of MetRs on the incidence of hepatic and cardiac outcomes. 7 , 39 Furthermore, it is important to exclude well-known clinical factors, such as chronic viral hepatitis and severe underlying comorbidities, related to the outcomes 21 , 22 , [32] , [33] , [34] , [35] , [36] , [37] , 40 to analyse the effects of MetR on FLD per se . Nevertheless, no study has yet evaluated the effects of MetRs on the incidence of outcomes in two different categories of patients with FLD after excluding confounding factors.…”

“…In fact, patients with AFLD and NAFLD often have varying numbers of comorbidities, and it is possible that the effects of comorbidities on AFLD and NAFLD outcomes can vary. 21 , 22 Therefore, the effects of MetRs on FLD outcomes should be analysed separately from the influence of comorbidities; however, no previous studies have used this approach.…”

Managing medicines in alcohol-associated liver disease: a practical review

“…non-alcoholic fatty liver disease), the prevalence of hypertension (32–41%), ischaemic heart disease (5–20%), heart failure (5–12%) and type 2 diabetes (26–29%) is notable. 45 , 46 Concomitant drugs prescribed for these conditions may require additional monitoring, especially in people with cirrhosis. In those with decompensated cirrhosis who are ineligible for liver transplant, deprescribing medicines for which benefit is with long-term use (e.g.…”

Comorbidity and multimorbidity in patients with cirrhosis, hospitalised in an internal medicine ward: a monocentric, cross-sectional study

“…To mention a few disease-related manifestations, ascites, hepatic encephalopathy, cell blood count alterations, coagulopathy and gastrointestinal bleeding, all have a negative impact on both physical and mental functioning 11. Additionally, patients with cirrhosis frequently have multiple chronic conditions,12–14 although their impact on prognosis remains unclear,14 and despite a distinction between comorbidity and multimorbidity has never been assessed. Besides its biological complexity, the impact of socioeconomic factors, that is, education, marital and employment status, household income, is an additional detrimental factor the effects of which appear to vary according to disease aetiology,15 16 and to have a relevant impact on survival and overall patients’ management 15 17.…”