Neil D Shah1, Meritxell Ventura-Cots2, Juan G Abraldes3, Mohamed Alboraie4, Ahmad Alfadhli5, Josepmaria Argemi6, Ester Badia-Aranda7, Enrique Arús-Soler8, A Sidney Barritt1, Fernando Bessone9, Marina Biryukova10, Flair J Carrilho11, Marlen Castellanos Fernández8, Zaily Dorta Guiridi10, Mohamed El Kassas12, Teo Eng-Kiong13, Alberto Queiroz Farias11, Jacob George14, Wenfang Gui15, Prem H Thurairajah13, John Chen Hsiang13, Azra Husić-Selimovic16, Vasily Isakov10, Mercy Karoney17, Won Kim18, Johannes Kluwe19, Rakesh Kochhar20, Narendra Dhaka20, Pedro Marques Costa21, Mariana A Nabeshima Pharm11, Suzane K Ono11, Daniela Reis21, Agustina Rodil11, Caridad Ruenes Domech8, Federico Sáez-Royuela7, Christoph Scheurich19, Way Siow14, Nadja Sivac-Burina16, Edna Solange Dos Santos Traquino8, Fatma Some17, Sanjin Spreckic16, Shiyun Tan22, Julio Vorobioff9, Andrew Wandera17, Pengbo Wu22, Mohamed Yacoub23, Ling Yang15, Yuanjie Yu22, Nerma Zahiragic16, Chaoqun Zhang22, Helena Cortez-Pinto21, Ramon Bataller24. 1. Division of Gastroenterology and Hepatology, Departments of Medicine and Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 2. Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Center for Liver Diseases, Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain. 3. Cirrhosis Care Clinic, Division of Gastroenterology (Liver Unit), University of Alberta, Centre of Excellence for Gastrointestinal Inflammation and Immunity Research (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, Department of Medicine, Center for Liver Diseases, Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania; 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, 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, Westmead Hospital, University of Sydney, Westmead, New South Wales, 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. Division of Gastroenterology and Hepatology, Department of Internal Medicine, 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, Lisbon, Portugal. 22. Department of Gastoenterology, Renmin Hospital of Wuhan University, Wuhan, China. 23. Hepatology Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt. 24. Division of Gastroenterology and Hepatology, Departments of Medicine and Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Center for Liver Diseases, Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania. Electronic address: bataller@pitt.edu.
Abstract
BACKGROUND & AIMS: Despite recent advances in treatment of viral hepatitis, liver-related mortality is high, possibly owing 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 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 hepatitis B virus infection, and 17% had nonalcoholic 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 with 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 health care providers, with more advanced disease, compared with patients without excess alcohol use. The mean model for end-stage liver disease score for patients with advanced ALD (score, 16) was higher than for patients with advanced liver disease not associated with excess alcohol use (score, 13) (P < .01). CONCLUSIONS: In a cross-sectional analysis of patients with liver disease worldwide, we found that patients with ALD are seen with more advanced-stage 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.
BACKGROUND & AIMS: Despite recent advances in treatment of viral hepatitis, liver-related mortality is high, possibly owing 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 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 hepatitis B virus infection, and 17% had nonalcoholic 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 with 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 health care providers, with more advanced disease, compared with patients without excess alcohol use. The mean model for end-stage liver disease score for patients with advanced ALD (score, 16) was higher than for patients with advanced liver disease not associated with excess alcohol use (score, 13) (P < .01). CONCLUSIONS: In a cross-sectional analysis of patients with liver disease worldwide, we found that patients with ALD are seen with more advanced-stage 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.
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