Risk for Alcoholic Liver Cirrhosis After an Initial Hospital Contact With Alcohol Problems: A Nationwide Prospective Cohort Study
Risk for Alcoholic Liver Cirrhosis After an Initial Hospital Contact With Alcohol Problems: A Nationwide Prospective Cohort Study
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DOI：
10.1002/hep.28943
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发表时间：
2017-03-01
期刊：
影响因子：
13.5
通讯作者：
Tolstrup, Janne S.
中科院分区：
文献类型：
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作者：
Askgaard, Gro;Leon, David A.;Tolstrup, Janne S.
酒精性肝硬化通常是由多年的大量饮酒，其中停止饮酒可以预防这种疾病。酒精问题在医院病人中没有得到一致的管理。我们在1998年至2002年期间对所有首次在医院接触酒精问题（中毒、有害使用或依赖）的丹麦患者进行了酒精性肝硬化发展随访（n = 36，044）。在这个基于登记的队列中，我们确定了酒精性肝硬化绝对风险的预测因子。发病率比（IRR）估计为这些患者相对于一般人群的酒精性肝硬化发病率。年龄和酒精诊断是男性和女性酒精性肝硬化风险的重要预测因素，而公民身份，教育和医院护理类型则不是。男性15年绝对风险为0.7%（95%置信区间[CI]，0.4，0.8）20-29年，5.5%（95% CI，4.9，6.2）30-39岁，9.8%（95% CI，9.0，11）40-49岁，8.9%（95% CI，8.1，9.8），60-69岁6.2%（95% CI，5.1，7.2），70-84岁2.5%（95% CI，1.7，3.3）。根据男性酒精诊断，15年绝对风险为2.6%（95% CI，2.3，2.9）中毒，7.7%（95% CI，6.4，7.9）有害使用，8.8%（95% CI，8.2，9.4）依赖。相对于一般人群，队列中酒精性肝硬化的IRR在男性中为11（95% CI，10，12），在女性中为18（95% CI，15，21）。结论：与一般人群相比，有酒精问题的住院患者患酒精性肝硬化的风险更大。40-59岁的患者和被诊断为有害使用或依赖的患者的风险尤其增加。
Alcoholic liver cirrhosis is usually preceded by many years of heavy drinking, in which cessation in drinking could prevent the disease. Alcohol problems are not consistently managed in hospital patients. We followed all Danish patients with an initial hospital contact with alcohol problems (intoxication, harmful use, or dependence) during 1998-2002 for alcoholic liver cirrhosis development (n = 36,044). In this registry-based cohort, we identified predictors of the absolute risk for alcoholic liver cirrhosis. Incidence rate ratios (IRRs) were estimated as the incidence rate of alcoholic liver cirrhosis in these patients relative to the general population. Age and alcohol diagnosis were significant predictors of alcoholic liver cirrhosis risk in men and women, whereas civil status, education, and type of hospital care were not. In men, the 15-year absolute risk was 0.7% (95% confidence interval [CI], 0.4, 0.8) for 20-29 years, 5.5% (95% CI, 4.9, 6.2) for 30-39 years, 9.8% (95% CI, 9.0, 11) for 40-49 years, 8.9% (95% CI, 8.1, 9.8) for 50-59 years, 6.2% (95% CI, 5.1, 7.2) for 60-69 years, and 2.5% (95% CI, 1.7, 3.3) for 70-84 years. According to alcohol diagnosis in men, the 15-year absolute risk was 2.6% (95% CI, 2.3, 2.9) for intoxication, 7.7% (95% CI, 6.4, 7.9) for harmful use, and 8.8% (95% CI, 8.2, 9.4) for dependence. The IRR for alcoholic liver cirrhosis in the cohort relative to the general population was 11 (95% CI, 10, 12) in men and 18 (95% CI, 15, 21) in women. Conclusion: Hospital patients with alcohol problems had a much greater risk for alcoholic liver cirrhosis compared to the general population. The risk was particularly increased for patients 40-59 years and for patients diagnosed with harmful use or dependence.