Mortality Risk and Decompensation in Hospitalized Patients with Non-Alcoholic Liver Cirrhosis: Implications for Disease Management

Here we aimed to assess the mortality risk and distribution of deaths from different complications and etiologies for non-alcoholic liver cirrhosis (NALC) adult inpatients and compare them with that of the general hospitalized adult population. Hospitalized patients with a primary diagnosis of NALC and aged between 30 and 80 years of age from 1999 to 2010 were identified using a population-based administrative claims database in Taiwan. They were matched with a general, non-NALC population of hospitalized patients. Causes of death considered were variceal hemorrhage, ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, hepatocellular carcinoma, jaundice, and hepatorenal syndrome. A total of 109,128 NALC inpatients were included and then matched with 109,128 inpatients without NALC. Overall mortality rates were 21.2 (95% CI: 21.0–21.4) and 6.27 (95% CI: 6.17–6.37) per 100 person-years, respectively. Among complications that caused death in NALC patients, variceal hemorrhage was the most common (23.7%, 11.9 per 100 person-years), followed by ascites (20.9%, 10.4 per 100 person-years) and encephalopathy (18.4%, 9.21 per 100 person-years). Among all etiologies, mortality rates were highest for NALC patients with HBV infection (43.7%, 21.8 per 100 person-years), followed by HBV-HCV coinfection (41.8%, 20.9 per 100 person-years), HCV infection (41.2%, 20.6 per 100 person-years), and NAFLD (35.9%, 17.9 per 100 person-years). In this study, we demonstrated that mortality risks in NALC patients may differ with their etiology and their subsequent complications. Patients’ care plans, thus, should be formulated accordingly.

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Su1527 Different Pattern of Hepatic Decompensation and Mortality in Hospitalized Patients With Alcoholic Versus Non-Alcoholic Liver Cirrhosis: A Population-Based Study

Gastroenterology ◽

10.1016/s0016-5085(16)33783-0 ◽

2016 ◽

Vol 150 (4) ◽

pp. S1121

Author(s):

Phunchai Charatcharoenwitthaya ◽

Ngamphol Soonthornworasiri ◽

Kittiyod Poovorawan ◽

Wirichada Pan-Ngum ◽

Watcharasak Chotiyaputta ◽

...

Keyword(s):

Liver Cirrhosis ◽

Population Based ◽

Hospitalized Patients ◽

Alcoholic Liver Cirrhosis ◽

Hepatic Decompensation ◽

Population Based Study

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1000 THE CLINICAL COURSE OF ALCOHOLIC LIVER CIRRHOSIS: A DANISH POPULATION-BASED STUDY

Journal of Hepatology ◽

10.1016/s0168-8278(09)61002-3 ◽

2009 ◽

Vol 50 ◽

pp. S362-S363

Author(s):

P. Jepsen ◽

H. Vilstrup ◽

P.K. Andersen ◽

P. Ott ◽

H.T. Sørensen

Keyword(s):

Liver Cirrhosis ◽

Clinical Course ◽

Population Based ◽

Alcoholic Liver Cirrhosis ◽

Danish Population ◽

Population Based Study

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Clinical course of alcoholic liver cirrhosis: A Danish population-based cohort study

Hepatology ◽

10.1002/hep.23500 ◽

2009 ◽

Vol 51 (5) ◽

pp. 1675-1682 ◽

Cited By ~ 240

Author(s):

Peter Jepsen ◽

Peter Ott ◽

Per Kragh Andersen ◽

Henrik Toft Sørensen ◽

Hendrik Vilstrup

Keyword(s):

Liver Cirrhosis ◽

Cohort Study ◽

Clinical Course ◽

Population Based ◽

Alcoholic Liver Cirrhosis ◽

Danish Population

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Dairy Consumption, Lactase Persistence, and Mortality Risk in a Cohort From Southern Sweden

Frontiers in Nutrition ◽

10.3389/fnut.2021.779034 ◽

2021 ◽

Vol 8 ◽

Author(s):

Emily Sonestedt ◽

Yan Borné ◽

Elisabet Wirfält ◽

Ulrika Ericson

Keyword(s):

Mortality Risk ◽

Fermented Milk ◽

Mortality Rates ◽

Population Based ◽

Lactase Persistence ◽

Dairy Consumption ◽

Health And Disease ◽

Prospective Cohorts ◽

Objective Marker

Background: Whether high dairy consumption is related to longevity is still unclear, and additional studies of prospective cohorts with high-quality dietary data from populations with wide consumption ranges are needed.Objective: To examine the association between dairy consumption and mortality in a Swedish cohort.Design: Among 26,190 participants (62% females, 45–73 years old) without diabetes and cardiovascular disease from the population-based Malmö Diet and Cancer cohort, 7,156 individuals died during a mean follow-up time of 19 years. Data on intake of dairy (non-fermented milk, fermented milk, cheese, cream and butter) were collected from 7 day food records and food questionnaires. A genetic marker (rs4988235) associated with lactase persistence was detected among 22,234 individuals born in Sweden.Results: Higher intakes up to 1,000 g/day of non-fermented milk were associated with only marginal higher mortality rates after adjusting for potential confounders. However, intakes above 1,000 g/day (1.5% of the population) were associated with 34% (95% CI: 14, 59%, p-trend=0.002) higher mortality compared to that with < 200 g/day. Fermented milk and cheese intake were inversely associated with mortality. Cream showed a protective association only among men. Butter was not associated with mortality. CT/TT genotype carriers (i.e., individuals with lactase persistence) had a 27% higher reported consumption of non-fermented milk, and non-significant higher mortality risk (HR = 1.08; 95% CI = 0.96, 1.23; p = 0.20) than CC genotype carriers.Conclusions: Higher mortality rates were mainly observed among participants consuming more than 1,000 g of non-fermented milk per day. In contrast, fermented milk and cheese were associated with lower mortality. Because dairy products differ in composition, it is important to examine them separately in their relation to health and disease. The use of a genetic variant as an objective marker of lactose-containing milk intake should be examined in relation to mortality in a larger population.

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Abstinence from Alcohol and Therapy for Alcohol Use Disorder in Alcoholic Liver Cirrhosis: An International Population-Based Study

Gastroenterology ◽

10.1016/s0016-5085(17)33642-9 ◽

2017 ◽

Vol 152 (5) ◽

pp. S1080

Author(s):

Evangelos Kalaitzakis ◽

José Cruanes ◽

Kristján Hauksson ◽

Anders Håkansson ◽

Konstantina Sargenti ◽

...

Keyword(s):

Liver Cirrhosis ◽

Alcohol Use ◽

Alcohol Use Disorder ◽

Population Based ◽

Alcoholic Liver Cirrhosis ◽

Population Based Study ◽

Abstinence From Alcohol

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Nutritional assessment and adequacy of dietary intake in hospitalized patients with alcoholic liver cirrhosis

British Journal Of Nutrition ◽

10.1079/bjn19930068 ◽

1993 ◽

Vol 69 (3) ◽

pp. 665-679 ◽

Cited By ~ 70

Author(s):

Klaus Nielsen ◽

Jens Kondrup ◽

Lars Martinsen ◽

Birgitte Stilling ◽

Berit Wikman

Keyword(s):

Body Weight ◽

Liver Cirrhosis ◽

Nutritional Status ◽

Dietary Intake ◽

Reference Values ◽

Nutritional Assessment ◽

Hospitalized Patients ◽

N Balance ◽

Alcoholic Liver Cirrhosis ◽

Dietary Recall

Nutritional assessment and adequacy of spontaneous dietary intake was evaluated in thirty-seven clinically stable hospitalized patients with alcoholic liver cirrhosis. About two-thirds of the patients had ascites or oedema, or both, and, therefore, body weight could not be used for assessment of nutritional status. Lean body mass (LBM; measured by three consecutive 24 h creatinine excretions) was 62 (range 40–95)% of reference values, mid-arm-muscle area (MAMA) was 70 (range 43–115)% and triceps skinfold (TSF) was 45 (range 20–113)% of reference values (all median values). In patients without ascites or oedema, or both, there was a rectilinear correlation between body weight and LBM and between body weight and MAMA (r 0.93 and 0.85 respectively). In patients with ascites or oedema, or both, the correlation between body weight and LBM was poor as could be expected. We suggest that LBM is a useful measure of nutritional status when body weight is unreliable because of ascites or oedema, or both. Energy balance for the group was calculated from energy intake recorded by a 24 h dietary recall and energy expenditure calculated by the factorial method. Median intake was 102 (range 34–176)% of expenditure. N loss was calculated from the average of three 24 h urea excretions. Protein intake was calculated from the 24 h dietary recall. The N balance was positive in the patients as a group (median intake was 120 (range 26–183)% of output). The most malnourished patients tended to have the most positive N balance which was due to a significantly lower N excretion. The protein requirement for N balance was 0.83 (SE 0.05) g/kg per d and only at an intake above 1.20 g/kg per d were all patients in positive N balance. The median intakes of thiamin, folacin, vitamin D, vitamin E, Mg, and Zn were judged to be insufficient. It is concluded that impaired nutritional status is common among patients with liver cirrhosis, even in a stable clinical condition. It is suggested that nutritional status in these patients is evaluated by dietary recalls, in combination with measurement of body weight in patients without ascites or oedema, or both, or in combination with determination of LBM by three 24 h creatinine excretions in patients with ascites or oedema, or both. Criteria for selection of patients that might benefit from nutritional therapy are discussed.

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Association between Liver Cirrhosis and Diabetes Mellitus: A Review on Hepatic Outcomes

Journal of Clinical Medicine ◽

10.3390/jcm10020262 ◽

2021 ◽

Vol 10 (2) ◽

pp. 262

Author(s):

Laura I. Coman ◽

Oana A. Coman ◽

Ioana A. Bădărău ◽

Horia Păunescu ◽

Mihai Ciocîrlan

Keyword(s):

Diabetes Mellitus ◽

Liver Cirrhosis ◽

Bacterial Infections ◽

Portal Pressure ◽

Population Based ◽

Variceal Hemorrhage ◽

Increased Risk ◽

Multicenter Clinical Trials ◽

Altered Liver ◽

The Impact

Background: Liver cirrhosis (LC) is largely associated with diabetes mellitus (DM). More than 80% of patients with LC manifest glucose intolerance and about 30% have type 2 DM. A particular and yet unrecognized entity is hepatogenous diabetes (HD), defined as impaired glucose regulation caused by altered liver function following LC. Numerous studies have shown that DM could negatively influence liver-related outcomes. Aim: We aimed to investigate whether patients with LC and DM are at higher risk for hepatic encephalopathy (HE), variceal hemorrhage (VH), infections and hepatocellular carcinoma (HCC). The impact of DM on liver transplant (LT) outcomes was also addressed. Methods: Literature search was performed in PubMed, Ovid, and Elsevier databases. Population-based observational studies reporting liver outcomes in patients with LC were included. Results: Diabetics are at higher risk for HE, including post-transjugular intrahepatic portosystemic shunt HE. DM also increases the risk of VH and contributes to elevated portal pressure and variceal re-bleeding, while uncontrolled DM is associated with increased risk of bacterial infections. DM also increases the risk of HCC and contributes to adverse LT outcomes. Conclusions: Patients with DM and LC may benefit from close follow-up in order to reduce readmissions and mortality. Due to the heterogeneity of available research, prospective multicenter clinical trials are needed to further validate these findings.

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