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No Change in Alcoholic Cirrhosis Mortality
in 20 Years-But Causes of Death Shift
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EASL International Liver Congress, June 23-26, 2021
Mark Mascolini
Five-year mortality with alcoholic cirrhosis has not changed in 20 years, according to a 435-person analysis in Belgium [1]. But causes of death from alcoholic cirrhosis did change, with increased mortality from sepsis and decreased mortality from acute gastrointestinal bleeding. Age at diagnosis of alcoholic cirrhosis and at death rose over time.
More than half of people with alcoholic cirrhosis may die within 5 years [2]. Researchers at Jolimont Hospital in La Louvière, Belgium set out to track potential changes in alcoholic cirrhosis mortality at their institution. They included people 18 or older who had an alcoholic cirrhosis diagnosis and divided them into two cohorts: Cohort 1 entered care from 1995 through 2004, and cohort 2 entered care from 2005 through 2014. The researchers excluded people diagnosed with cirrhosis more than 2 years before entering their cohort, and they eliminated people lost to follow-up (dropped out of care).
Among 932 people with cirrhosis from 1995 through 2014, 565 (61%) had alcoholic cirrhosis and 435 (47%) did not get excluded for the reasons listed above. Cohort 1 (1995-2004) included 206 people (47% of 435), and cohort 2 (2005-2014) had 229 members (53%). Eighty people in cohort 1 (39%) died, and the researchers labeled them group A. Eighty-three people in cohort 2 (36%) died, and they became group B.
Compared with group A (1995-2004), group B (2005-2014) had an older average age at diagnosis (58.6 vs 54.7, P = 0.03) and an older age at death (61.3 vs 57.2, P = 0.02). But group A and B did not differ significantly in mortality within 5 years (39% and 36%), in survival time (27 and 34 months), or in average Child-Pugh score at inclusion (7.91 and 7.82).
Nor did group A (1995-2004) differ significantly from group B (2005-2014) in rates of liver-related mortality (80% and 81%) or end-stage liver disease (36% and 29%). Two causes of liver-related death did change significantly from 1995-2004 (group A) to 2005-2014 (group B): Liver-related death from gastrointestinal bleeding fell significantly from the earlier period to the later period (30% to 9%, P = 0.003), while sepsis became a more frequent cause of death in the more recent period (1.5% to 14%, P = 0.009). Frequency of three other liver-related causes of death did not change significantly from the earlier period to the later period: severe alcoholic hepatitis (17% to 18%), hepatocellular carcinoma or cholangiocarcinoma (9% to 15%), and other causes (6% to 14%).
References
1. Kaze E, Henrion J. Has the 5-year mortality of patients with alcoholic cirrhosis changed during the last 20 years? EASL International Liver Congress, June 23-26, 2021. Abstract PO-488.
2. Jepsen P, Ott P, Andersen PK, Sørensen HT, Vilstrup H. Clinical course of alcoholic liver cirrhosis: a Danish population-based cohort study. Hepatology. 2010;51:1675-1682.
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