Trends in Characteristics, Mortality, and Other Outcomes of Patients With Newly Diagnosed Cirrhosis

Abstract

IMPORTANCE Changes in the characteristics of patients with cirrhosis are likely to affect future outcomes and are important to understand in planning for the care of this population. OBJECTIVE To identify changes in demographic and clinical characteristics and outcomes in patients with newly diagnosed cirrhosis. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study of patients with a new diagnosis of cirrhosis was conducted using the Indiana Network for Patient Care, a large statewide regional health information exchange, between 2004 and 2014. Patients with at least 1 year of continuous follow-up before the cirrhosis diagnosis were followed up through August 1, 2015. The analysis was conducted from December 2018 to January 2019. EXPOSURES Age, cause of cirrhosis, and year of diagnosis. MAIN OUTCOMES AND MEASURES Overall rates for mortality, liver transplant, hepatocellular carcinoma, and hepatic decompensation (composite of ascites, hepatic encephalopathy, or variceal bleeding). RESULTS A total of 9261 patients with newly diagnosed cirrhosis were identified (mean [SD] age, 57.9 [12.6] years; 5109 [55.2%] male). A 69% increase in new diagnoses occurred over the course of the study period (620 in 2004 vs 1045 in 2014). The proportion of those younger than 40 years increased by 0.20% per year (95% CI, 0.04% to 0.36%; P for trend = .02), and the proportion of those aged 65 years and older increased by 0.81% per year (95% CI, 0.51% to 1.11%; P for trend < .001). The proportion of patients with alcoholic cirrhosis increased by 0.80% per year (95% CI, 0.49% to 1.12%), and the proportion with nonalcoholic steatohepatitis increased by 0.59% per year (95% CI, 0.30% to 0.87%), whereas the proportion with viral hepatitis decreased by 1.36% per year (95% CI, −1.68% to −1.03%) (P < .001 for all). In patients younger than 40 years, 40 to 64 years, and 65 years and older, mortality rates were 6.4 (95% CI, 5.4 to 7.6), 9.9 (95% CI, 9.5 to 10.4), and 16.2 (95% CI, 15.2 to 17.2) per 100 person-years, respectively (P < .001). Mortality rates decreased during the study period (11.9 [95% CI, 10.7-13.1] per 100 person-years in 2004 vs 10.0 [95% CI, 8.1-12.2] per 100 person-years in 2014; annual adjusted hazard ratio, 0.87 [95% CI, 0.86 to 0.88]) and were lower in those with alcoholic cirrhosis compared with patients with viral hepatitis (adjusted hazard ratio, 0.89 [95% CI, 0.80 to 0.98]). Rates of hepatocellular carcinoma were low in patients younger than 40 years (0.5 [95% CI, 0.2 to 0.9] per 100 person-years). Liver transplant rates were low throughout the study period (0.3 [95% CI, 0.3-0.4] per 100 person-years). In patients with compensated cirrhosis, rates of hepatic decompensation were lower in patients younger than 40 years (adjusted subhazard ratio 0.78; 95% CI, 0.62 to 0.99) and in patients with nonalcoholic steatohepatitis (adjusted subhazard ratio, 0.51; 95% CI, 0.43 to 0.60).

Cirrhosis Is Associated With Worse Outcomes in Ischemic Colitis: A Nationwide Retrospective Study

“…Compared to patients without cirrhosis, patients with IC and cirrhosis were more likely to be male, black and Hispanic, although patients in both groups were predominantly White. In contrast, the population of cirrhosis in the USA trends toward male, non-Hispanic blacks and Mexican-Americans, and are of older age [ 17 - 19 ]; however, the population dynamics of cirrhosis continue to change over time, and are expected to continue to do so, as rates of NASH and alcohol-related cirrhosis continue to increase and rates of hepatitis C-related cirrhosis decline [ 20 ].…”

Decreasing Incidence of Alcohol-Related Liver Disease in Denmark: A 25-Year Nationwide Study

“…In the United States, the in-hospital mortality rate of ALD has decreased between 2005–2014, 39 and the mortality rate of ALD cirrhosis has decreased between 2004 and 2014. 40 The cause of the decreased ALD mortality is difficult to ascertain. Nevertheless, our data provide a few hints.…”

Trends in surgical volume and in-hospital mortality among United States cirrhosis hospitalizations

“…Second, the data may alternatively suggest an increasingly conservative approach to surgery that may potentially be explained by risk aversion attributable to a higher-risk patient population. A statewide population-based study found that new diagnoses of cirrhosis increased by 69% (from 620 to 1045) between 2004 and 2014 [ 12 ], with the greatest increase occurring in patients aged 65 years and older. Over the same time period, a study of 126 Veteran Administration hospitals showed that, while in-hospital mortality decreased from 11.4% to 7.6% among cirrhosis hospitalizations, 30-day post-discharge mortality increased from 9.3% to 10.1% [ 13 ].…”