People with alcohol-related liver disease have a significantly higher risk of decompensation and liver-related deaths than people with other forms of chronic liver disease, research shows.
A Western Australian study of about 11,000 patients with chronic liver disease between 2004 to 2015 identified hepatitis C, hepatitis B and NAFLD as more common causes of liver disease than alcohol.
However the study found the 5-year cumulative risk of all cause deaths was 10.5% across the whole cohort but significantly higher – at 33.3% – in the subgroup of patients with alcohol-related liver disease.
The 5-year cumulative risk of liver-related deaths across the whole cohort was 4.5% and ranged from 2.8% in patients with NAFLD, 2.8% in HBV patients and 3.1% in HCV patients up to 17.1% in people with alcohol-related liver disease.
A significant difference between the subgroups of liver patients was also seen in their 5-year cumulative risk of decompensation.
The study found that people with alcohol-related liver disease, with or without additional metabolic risk factors, and those with autoimmune liver disease had a higher risk of decompensation compared to patients with hepatitis or NAFLD.
“Multivariate analysis adjusting for age, gender and cirrhosis status found that ALD [alcohol-related liver disease] had a significantly higher risk of liver-related death (HR 2.39) and decompensation (HR: 3.42) compared to HCV,” the study authors said.
“This suggested that the high mortality rate in ALD may be due to a combination of a delayed diagnosis and more rapid progression to decompensation and liver-related death compared to other causes of chronic liver disease.”
In other liver outcomes, transplantation was most common in patients with autoimmune overlap syndrome (26.3%).
The risk of hepatocellular carcinoma was a low 1.69% across the whole cohort with no significant difference between the patient subgroups.
The researchers, led by Professor Gary Jeffrey from Sir Charles Gairdner Hospital and the University of Western Australia, noted a higher risk of liver-related deaths in NAFLD patients in their cohort than in previous population-based studies.
“This finding combined with the extremely high prevalence of NAFLD in the population makes this preventable liver disease one of the most pressing problems in public health today,” they said.
They added there was currently limited information on patients who met the diagnostic criteria for alcoholic liver disease but also had the metabolic risk factors for NAFLD.
Their study found patients with the combination of alcohol and metabolic risk factors had an intermediate risk of liver-related death and decompensation when compared with patients with either alcohol-related disease or NAFLD alone.