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Clin Gastroenterol Hepatol. 2019 Jan 29. pii: S1542-3565(19)30073-4. doi: 10.1016/j.cgh.2019.01.026. [Epub ahead of print]

Alcohol-related Liver Disease is Rarely Detected at Early Stages Compared With Liver Diseases of Other Etiologies Worldwide.

Author information

1
Division of Gastroenterology & Hepatology, Departments of Medicine and Nutrition, University of North Carolina at Chapel Hill, NC.
2
Division of Gastroenterology, Hepatology, and Nutrition, Deparment of Medicine, Center for Liver Diseases, Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, PA; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain.
3
Cirrhosis Care Clinic, Division of Gastroenterology (Liver Unit), University of Alberta, CEGIIR, Edmonton, Canada.
4
Haya Al-Habeeb Gastroenterology Center, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait; Department of Internal Medicine, Al-Azhar University, Cairo, Egypt.
5
Haya Al-Habeeb Gastroenterology Center, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait.
6
Division of Gastroenterology, Hepatology, and Nutrition, Deparment of Medicine, Center for Liver Diseases, Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, PA; Liver Unit, Clinica Universidad de Navarra, Pamplona, Spain.
7
Gastroenterology Department, Liver Unit, Hospital Universitario de Burgos, Burgos; Spain.
8
Department of Hepatology, Instituto de Gastroenterología, Havana, Cuba.
9
Department of Gastroenterology and Hepatology from the University of Rosario School of Medicine, Rosario, Argentina.
10
Department of Gastroenterology and Hepatology, Federal Research Center for Nutrition, Biotechnology and Food Safety, Moscow, Russia.
11
Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil.
12
Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt.
13
Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.
14
Storr Liver Centre, Westmead Millennium Institute and Westmead Hospital, University of Sydney, Westmead, NSW, Australia.
15
Division of Gastroenterology, Union Hospital, Huazhong University of Science and Technology, Wuhan, China.
16
Department of Hepatology, Institute for Gastroenterology, University Hospital Sarajevo, Sarajevo, Bosnia and Herzegovina.
17
Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.
18
Department of Internal Medicine, Division of Gastroenterology and Hepatology Seoul National University College of Medicine Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea.
19
Department of Gastroenterology and Hepatology, University Medical Center, Hamburg-Eppendorf, Germany.
20
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
21
Departmento de Gastrenterologia e Hepatologia, Centro Hospitalar Lisboa Norte, Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Portugal.
22
Division of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China.
23
Division of Gastroenterology & Hepatology, Departments of Medicine and Nutrition, University of North Carolina at Chapel Hill, NC; Division of Gastroenterology, Hepatology, and Nutrition, Deparment of Medicine, Center for Liver Diseases, Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, PA. Electronic address: bataller@pitt.edu.

Abstract

BACKGROUND & AIMS:

Despite recent advances in treatment of viral hepatitis, liver-related mortality is high, possibly due to the large burden of advanced alcohol-related liver disease (ALD). We investigated whether patients with ALD are initially seen at later stages of disease development than patients with hepatitis C virus (HCV) infection or other etiologies.

METHODS:

We performed a cross-sectional study of 3453 consecutive patients with either early or advanced liver disease (1699 patients with early and 1754 with advanced liver disease) seen at 17 tertiary care liver or gastrointestinal units worldwide, from August 2015 through March 2017. We collected anthropometric, etiology, and clinical information as well as and model for end-stage liver disease (MELD) scores. We used unconditional logistic regression to estimate the odds ratios for evaluation at late stages of the disease progression.

RESULTS:

Of the patients analyzed, 81% had 1 etiology of liver disease and 17% had 2 etiologies of liver disease. Of patients seen at early stages for a single etiology, 31% had HCV infection, 21% had HBV infection, and 17% had non-alcoholic fatty liver disease, whereas only 3.8% had ALD. In contrast, 29% of patients seen for advanced disease had ALD. Patients with ALD were more likely to be seen at specialized centers, with advanced-stage disease, compared to patients with HCV-associated liver disease (odds ratio, 14.1; 95% CI, 10.5-18.9; P <.001). Of patients with 2 etiologies of liver disease, excess alcohol use was associated with 50% of cases. These patients had significantly more visits to healthcare providers, with more advanced disease, compared to patients without excess alcohol use. The mean MELD score for patients with advanced ALD (16) was higher than for patients with advanced liver disease not associated with excess alcohol use (13) (P<.01).

CONCLUSION:

In a cross-sectional analysis of patients with liver disease worldwide, we found that patients with ALD are seen with more advanced-staged disease than patients; with HCV-associated liver disease. Of patients with 2 etiologies of liver disease, excess alcohol use was associated with 50% of cases. Early detection and referral programs are needed for patients with ALD, worldwide.

KEYWORDS:

NAFLD; cirrhosis; mortality

PMID:
30708110
DOI:
10.1016/j.cgh.2019.01.026

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