Alcohol-Related Liver Disease Is Rarely Detected at Early Stages Compared With Liver Diseases of Other Etiologies Worldwide
Alcohol-Related Liver Disease Is Rarely Detected at Early Stages Compared With Liver Diseases of Other Etiologies Worldwide
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DOI：
10.1016/j.cgh.2019.01.026
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发表时间：
2019-10-01
影响因子：
12.6
通讯作者：
Bataller, Ramon
中科院分区：
文献类型：
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作者：
Shah, Neil D.;Ventura-Cots, Meritxell;Bataller, Ramon
背景与目的：尽管最近在治疗病毒性肝炎方面取得了进展，但肝脏相关的死亡率很高，可能是由于晚期酒精相关肝病（ALD）的巨大负担。我们调查了ALD患者最初是否出现在疾病发展的后期阶段，而不是丙型肝炎病毒（HCV）感染或其他病因的患者。我们对3453例早期或晚期肝病患者进行了横断面研究2015年8月至2017年3月，全球17个三级肝脏或胃肠道护理单位就诊（1699名早期肝病患者和1754名晚期肝病患者）。我们收集了人体测量学、病因学和临床信息，以及终末期肝病评分模型。我们采用非条件Logistic回归估计的比值比评估在晚期阶段的疾病progress.RESULTS：分析的患者中，81%有1个病因的肝脏疾病和17%有2个病因的肝脏疾病。在单一病因的早期患者中，31%患有HCV感染，21%患有B肝炎病毒感染，17%患有非酒精性脂肪肝，而只有3.8%患有ALD。相比之下，29%的晚期疾病患者患有ALD。与HCV相关性肝病患者相比，ALD患者更可能在专业中心就诊，疾病晚期（优势比，14.1; 95%CI，10.5-18.9; P <0.001）。在有2种肝病病因的患者中，50%的病例与过量饮酒有关。与没有过量饮酒的患者相比，这些患者有更多的医疗保健提供者，更先进的疾病。晚期ALD患者的终末期肝病评分平均模型（评分，16）高于与过量饮酒无关的晚期肝病患者（得分，13分）结论：在对全球肝病患者的横断面分析中，我们发现ALD患者比HCV相关性肝病患者有更多的晚期疾病。在有2种肝病病因的患者中，50%的病例与过量饮酒有关。全世界的ALD患者都需要早期发现和转诊计划。
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.