The important role of immunization in alcoholic and non‐alcoholic chronic liver disease: A population‐based study

Abstract

To determine differences in frequencies of vaccine-preventable diseases between alcoholic liver disease (ALD) and non-alcoholic liver disease (NALD) patients. Methods: This population-based cohort study used USA national inpatient sample ICD-9 codes from January 2012 to September 2015. Frequencies of admissions for ALD and NALD in patients with pneumococcal pneumonia, influenza, herpes zoster virus, varicella zoster virus, hepatitis A, hepatitis B, human papilloma virus, meningococcal meningitis, diphtheria, pertussis and tetanus were measured. Frequencies and patients' characteristics were compared for ALD and NALD using χ 2 test and multivariate logistic regression analysis. Results: There was no difference in admissions for hepatitis A and pneumococcal pneumonia between the ALD and NALD groups. There were fewer admissions for hepatitis B (1.17% vs 1.80%, odds ratio [OR] 0.64, P < 0.01), herpes zoster (0.12% vs 0.17%, OR 0.69, P < 0.01), influenza (0.16% vs 0.26%, OR 0.59, P < 0.01) and all others (0.005% vs 0.015%, OR 0.36, P = 0.01) in the ALD group than the NALD group. The extreme all patient refined-diagnosis related groups mortality risk was 15.24% in ALD and 7.77% in NALD admissions (P < 0.0001). Conclusions: The most frequent vaccine-preventable disease in both groups was hepatitis B. Patients with NALD had higher odds of admissions for hepatitis B, herpes zoster virus, influenza and other vaccine-preventable disease than ALD patients. However, the ALD group had a higher risk of mortality when admitted to hospital with a vaccine-preventable disease than the NALD group. K E Y W O R D S vaccination, vaccine-preventable disease, alcoholic liver diseases, non-alcoholic liver diseases, hepatitis B 1 | INTRODUCTION Chronic liver disease (CLD) has affected over 45 million people worldwide, contributing a significant disease burden to both individuals and institutions. 1 The liver, owing to its high degree of vascularity and a capillary system that is lined with immune cells, plays a major role in the immune system and liver disease may result in decreased opsonization, reticuloendothelial cellular activity and neutrophil mobilization with increased bacterial translocation. 2 In alcoholic liver disease (ALD) in particular, hepatic dendritic cells may become impaired, impacting their cell-mediated response towards certain viral infections. 3,4 CLD, including ALD and non-alcoholic liver disease (NALD),

Impfungen bei gastroenterologischen Erkrankungen und Immunsuppression

“…Eine groß angelegte Studie aus den USA mit mehr als 200 000 Patienten, die an durch Impfung verhinderbare Infektionserkrankungen litten, zeigte eine Krankenhausmortalität von 15,24 % und 7,77 % für Patienten mit alkoholischer bzw. nicht alkoholischer Lebererkrankung [2]. Das unterstreicht, dass die chronische Lebererkrankung auch ohne Zirrhose zu einem schweren Verlauf von Infektionskrankheiten führen kann.…”

“…Auch für chronische Lebererkrankungen sollte daher gelten, was bei chronisch entzündlichen Darmerkrankungen gilt: den Immunstatus zu überprüfen und wenn nötig zu impfen. Dies gilt vor allem für Hepatitis A und Hepatitis B, aber auch für Influenza, Pneumokokken und Herpes zoster, zumal die letzteren Infektionen häufiger zu Hospitalisierungen führen als beispielsweise eine Hepatitis A [2].…”

Letter to the editor: vaccination against upper respiratory infections is a matter of survival in alcoholic liver disease

“…With respect to upper airway respiratory infections, patients with chronic liver disease, including those with ALD, are particularly susceptible to infections as the immune system is dysfunctional through several pathological mechanisms including decreased opsonisation, reticuloendothelial dysfunction, neutrophils impairment and abnormal immunoglobulin synthesis 4 5. Moreover, alcohol abuse, independently from other factors, depresses the immune system by decreasing the lymphocytes and antibodies and the production of cytokines as TNF-alpha, IL-1 and IL-6 6. Several human and murine studies have reported that patients with chronic alcohol consumption are at higher risk of severe influenza 7.…”

“… 4 5 Moreover, alcohol abuse, independently from other factors, depresses the immune system by decreasing the lymphocytes and antibodies and the production of cytokines as TNF-alpha, IL-1 and IL-6. 6 Several human and murine studies have reported that patients with chronic alcohol consumption are at higher risk of severe influenza. 7 Thus, respiratory infections such as seasonal flue or SARS-CoV-2 represent a major threat to these patients.…”