Mortality in biopsy-proven alcohol-related liver disease: a population-based nationwide cohort study of 3453 patients
Mortality in biopsy-proven alcohol-related liver disease: a population-based nationwide cohort study of 3453 patients
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DOI：
10.1136/gutjnl-2019-320446
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发表时间：
2021-01-01
期刊：
影响因子：
24.5
通讯作者：
Ludvigsson, Jonas F.
中科院分区：
文献类型：
--
作者：
Hagstrom, Hannes;Thiele, Maja;Ludvigsson, Jonas F.
目的酒精性肝病(ALD)患者的死亡风险增加，但与普通人群相比，很少有研究探讨组织学严重程度的意义或估计的相对风险。我们检查了全国范围内经活检证实的ALD人群的死亡率。在瑞典设计了基于人群的队列研究，比较了1969至2017年间具有ALD国际分类(ICD)代码的3453名个体和16名匹配的普通人群个体的肝脏活检。使用瑞典国家登记来确定总体和疾病特定死亡率，最迟在首次ICD诊断或肝脏活检加3个月后开始随访。结果诊断时年龄中位数为58岁，男性占65%，肝硬变患者占52%。ALD患者的5年累积死亡率为40.9%，而参照组为5.8%。总死亡率显著增加(调整后的HR(AHR)=4.70，95%CI为4.35至5.08)。与肝脏相关的死亡风险特别高(占所有死亡的43%，AHR=167.6，95%CI为101.7至276.3)。无肝硬变的ALD患者的死亡率也显著增加，在基线后第一年最高，但在随访10年后仍持续(AHR=2.74，95%可信区间2.37至3.16)。结论经活检证实的ALD患者的死亡风险是普通人群的近5倍。没有肝硬变的ALD患者的死亡风险也增加了，重申了在对这些患者的管理中提高警惕的必要性。
Objective Patients with alcohol-related liver disease (ALD) are at increased risk of death, but studies have rarely investigated the significance of histological severity or estimated relative risks compared with a general population. We examined mortality in a nationwide cohort of biopsy-proven ALD.Design Population-based cohort study in Sweden comparing 3453 individuals with an International Classification of Disease (ICD) code for ALD and a liver biopsy from 1969 to 2017 with 16 535 matched general population individuals. Swedish national registers were used to ascertain overall and disease-specific mortality, starting follow-up at the latest of first ICD diagnosis or liver biopsy plus 3 months. Cox regression adjusted for relevant confounders was used to estimate HRs in ALD and histopathological subgroups.Results Median age at diagnosis was 58 years, 65% were men and 52% had cirrhosis at baseline. Five-year cumulative mortality was 40.9% in patients with ALD compared with 5.8% in reference individuals. The risk for overall mortality was significantly increased (adjusted HR (aHR)=4.70, 95% CI 4.35 to 5.08). The risk of liver-related death was particularly high (43% of all deaths, aHR=167.6, 95% CI 101.7 to 276.3). Mortality was significantly increased also in patients with ALD without cirrhosis and was highest in the first year after baseline but persisted after >= 10 years of follow-up (aHR=2.74, 95% CI 2.37 to 3.16).Conclusion Individuals with biopsy-proven ALD have a near fivefold increased risk of death compared with the general population. Individuals with ALD without cirrhosis were also at increased risk of death, reaffirming the need to increase vigilance in the management of these individuals.