Incidence, clinical presentation and mortality of liver cirrhosis in Southern Sweden: a 10‐year population‐based study

Nilsson, Emma; Anderson, Harald; Sargenti, Konstantina; Lindgren, Stefan; Prytz, Hanne

doi:10.1111/apt.13635

Cited by 54 publications

(90 citation statements)

References 24 publications

(31 reference statements)

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“…Gastroesophageal varices indicate an advanced state of cirrhosis and half of the patients died without LT within five years after inclusion. In accordance with other studies [8,9], about two of three patients in our study died as a consequence of the liver disease, and a substantial fraction of the patients died due to variceal bleeding. Notably, in the subgroup of 151 patients with no variceal bleeding before or at inclusion, 7.9% died due to variceal bleeding during follow up, despite varices being diagnosed previously.…”

Section: Discussionsupporting

confidence: 93%

“…Whether prognosis is different in patients with ALD than in other groups is still under debate. A Swedish study reported increased mortality among patients with ALD compared to HCV patients without high alcohol consumption [9]. Likewise, Marot et al found reduced long term survival in ALD patients who continued drinking [8], in abstainers, however, survival was similar in patients with ALD, NAFLD and HCV infection, as also reported in a Japanese study comparing survival in patients with ALD and HCV infection [18].…”

Section: Discussionmentioning

confidence: 74%

“…Among 752 patients with cirrhosis due to ALD, NAFLD or HCV infection, 36% increased mortality was observed in males [8]. In a Swedish study of 1317 patients with cirrhosis, mortality was reduced by 25% in women [9]. On the other hand, in a study exploring safety of carvedilol in 264 cirrhotic patients with ascites, gender had no effect on survival [10].…”

Section: Discussionmentioning

confidence: 99%

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Effect of gender on mortality and causes of death in cirrhotic patients with gastroesophageal varices. A retrospective study in Norway

Haukeland¹,

Småstuen²,

Pålsdatter³

et al. 2020

PLoS ONE

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Background & aimsThe prognostic role of gender in patients with liver cirrhosis is not fully understood. Our primary aim was to assess how gender affects cumulative incidence and risk of death without liver transplantation (LT) in cirrhotic patients with gastroesophageal varices. Secondary aims were to assess the relationship between gender and cause specific death, risk of variceal bleeding and incidence rates of gastroesophageal varices in patients with cirrhosis. MethodsAll new patients with gastroesophageal varices due to liver cirrhosis at Oslo University Hospital between 2006 and May 2016 were identified. Clinical data were retrieved retrospectively from hospital files. Causes of death were classified according to a specified protocol in cases of in-hospital-death, otherwise by data from the Norwegian Death Registry. Competing risk analyses were used to calculate cumulative incidences and risks of i) all-cause death, ii) cause-specific death and iii) variceal bleeding or re-bleeding. ResultsCumulative one-and five years incidence of death without LT in 266 included patients were 28% and 51%, respectively. In univariate analysis, risk of death was positively associated with age, Child Pugh class, alcoholic liver disease and presentation with variceal bleeding, and negatively associated with female sex. In a multivariate model, risk of death without LT was associated with female sex ]), age (SHR 1.05 [1.04-1.07] per year), Child Pugh class B (SHR 1.54 [1.03-2.32]) and Child Pugh class C (SHR 4.29 [2.57-7.17]). Variceal bleeding caused 27% of deaths. Adjusting for age and Child Pugh score, a trend towards reduced risk of death due to variceal bleeding was seen in women (SHR 0.53; PLOS ONE PLOS ONE | https://doi.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

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Effect of gender on mortality and causes of death in cirrhotic patients with gastroesophageal varices. A retrospective study in Norway

Haukeland¹,

Småstuen²,

Pålsdatter³

et al. 2020

PLoS ONE

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“…HCV infection continues to be the most common aetiological factor observed in cirrhotic patients in Italy, a figure widely differing from what observed in North Europe, where alcohol overconsumption is the most common cause of liver cirrhosis, as recently confirmed by a Swedish study [26] showing that 58% of cirrhosis cases were due to a risky alcohol intake.…”

Section: Discussionmentioning

confidence: 89%

Characteristics of liver cirrhosis in Italy: Evidence for a decreasing role of HCV aetiology

Stroffolini

Sagnelli

Gaeta

et al. 2017

European Journal of Internal Medicine

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“…In Europe, cirrhosis is mainly alcohol‐related whereas in Asia and sub‐Saharan Africa, more than half of the cases can be attributed to hepatitis B and hepatitis C . The dominating causes in Sweden are alcohol overconsumption and hepatitis C …”

Section: Introductionmentioning

confidence: 99%

Clinical course and mortality by etiology of liver cirrhosis in Sweden: a population based, long‐term follow‐up study of 1317 patients

Nilsson

Anderson

Sargenti

et al. 2019

Aliment Pharmacol Ther

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Background: Liver cirrhosis is characterized by a silent phase until decompensation, which is defined by ascites, bleeding from esophageal varices or hepatic encephalopathy. Aim: To compare the clinical course, patterns of survival and causes of death by etiology during long-term follow-up in a large population-based cohort of patients with incident cirrhosis. Methods: We used population-based medical registries for a cohort study of patients with liver cirrhosis diagnosed January 2001 to December 2010, in the Scania region of Sweden. Medical records were reviewed. Patients were classified according to etiology and clinical parameters were registered. Patients were followed until December 2017. Results:The cohort comprised 1317 patients, 631 were decompensated at diagnosis and 387 decompensated during follow-up. The cumulative 10-year incidence of decompensation, with death and transplantation as competing risks, was 89% in alcoholic cirrhosis, 58% in hepatitis C and 75% in cryptogenic cirrhosis. The lowest 10-year transplantation-free survival rates were found in cryptogenic cirrhosis (11%), alcohol-related cirrhosis (18%) and alcohol combined with hepatitis C (12%).Autoimmune hepatitis cirrhosis showed the best 10-year survival (53%) and hepatitis C, non-alcoholic steatohepatitis, primary biliary cholangitis, and primary sclerosing cholangitis and other causes averaged 30%. Decompensation at diagnosis was an important predictor for death in all etiologies apart from alcoholic cirrhosis. 991 patients died and 91 were transplanted. Conclusion:Our results show that the clinical course and survival in cirrhosis differ considerably by both etiology and state at diagnosis.

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Incidence, clinical presentation and mortality of liver cirrhosis in Southern Sweden: a 10‐year population‐based study

Abstract: Sweden continues to have a low incidence of cirrhosis compared with other European countries. Mortality varies with gender, aetiology and severity at diagnosis. Patients with alcoholic cirrhosis with concomitant HCV infection fare worst.

Cited by 54 publications

References 24 publications

Effect of gender on mortality and causes of death in cirrhotic patients with gastroesophageal varices. A retrospective study in Norway

Effect of gender on mortality and causes of death in cirrhotic patients with gastroesophageal varices. A retrospective study in Norway

Characteristics of liver cirrhosis in Italy: Evidence for a decreasing role of HCV aetiology

Clinical course and mortality by etiology of liver cirrhosis in Sweden: a population based, long‐term follow‐up study of 1317 patients

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