Translational Health Economics Network (THEN), Paris, France; Infection Antimicrobials Modeling & Evolution (IAME), UMR 1137, Institut National de la Santé et de la Recherche Médicale (INSERM) - Université Paris Diderot, Sorbonne Paris Cité, France.
Translational Health Economics Network (THEN), Paris, France.
J Hepatol. 2017 Sep;67(3):454-461. doi: 10.1016/j.jhep.2017.03.031. Epub 2017 Apr 8.
BACKGROUND & AIMS: Hepatitis C virus (HCV) patients are at risk of alcohol use disorders (AUDs). We measured the contribution of AUDs on the burden of chronic HCV infection in French HCV patients.
The hospital trajectory of 97,347 French HCV patients aged 18-65 in January 2008 were tracked and followed until in-hospital death or December 2013. Primary outcome was the frequency of liver-related complications. Secondary outcomes were the frequency of liver transplantation and otherwise cause-specific mortality. Adjusted odds ratios (OR), population attributable risks of AUDs and other cofactors of liver disease progression associated with HCV transmission were measured.
The 28,101 (28.9%) individuals with AUDs had the highest odds for liver-related complications (OR=7.19; 95% confidence interval [CI], 6.90 to 7.50), liver transplantation (OR=4.28; 95% CI, 3.80 to 4.82), and liver death (OR=6.20; 95% CI, 5.85 to 6.58). Alcohol rehabilitation and abstinence were associated with 60% (95% CI, 57% to 63%) and 78% (95% CI, 76% to 80%) reduction of liver-related complications, respectively. The attributable risk of AUDs was 71.8% (95% CI, 66.0 to 76.8) of 17,669 liver-related complications, 67.4% (95% CI, 61.6 to 72.4) of 1,599 liver transplantations, and 68.8% (95% CI, 63.4 to 73.5) of 6,677 liver deaths. The number of liver transplantations remained stable and the number of liver deaths increased, at a faster rate for individuals with AUDs, over the observational period.
In France, AUDs contributed to more than two-thirds of the burden of chronic HCV infection in young and middle-aged adults over 2008-2013.
This study tracked liver-related complications and mortality of all 97,347 young and middle-aged patients (18-65years old) discharged with chronic HCV infection from French hospitals over 2008-2013. About 30% patients were recorded with alcohol use disorders (AUDs) and had the highest odds for liver-related complications (i.e. decompensated cirrhosis and liver cancer). AUDs contributed to more than two-thirds of 1,599 liver transplantations and 6,677 liver deaths recorded in patients with chronic HCV infection over 2008-2013 in France. Alcohol rehabilitation and abstinence were associated with above a 50% risk reduction of liver-related complications. Promoting alcohol abstinence should receive high priority to reduce the burden of chronic HCV infection.
丙型肝炎病毒（HCV）感染者存在发生酒精使用障碍（AUD）的风险。本研究旨在评估 AUD 对法国 HCV 感染者慢性 HCV 感染负担的影响。
2008 年 1 月，我们对 97347 例年龄在 18-65 岁之间的法国 HCV 感染者的住院轨迹进行了跟踪，并随访至院内死亡或 2013 年 12 月。主要结局为肝脏相关并发症的发生频率。次要结局为肝移植和其他病因特异性死亡率。测量了调整后的比值比（OR）、AUD 及其他与 HCV 传播相关的肝病进展的归因风险，并评估了它们对结局的影响。
28101 例（28.9%）AUD 感染者发生肝脏相关并发症的可能性最高（OR=7.19；95%置信区间[CI]，6.90-7.50）、发生肝移植（OR=4.28；95% CI，3.80-4.82）和肝死亡（OR=6.20；95% CI，5.85-6.58）的可能性也最高。酒精康复和戒酒分别与 60%（95% CI，57%-63%）和 78%（95% CI，76%-80%）的肝脏相关并发症风险降低相关。AUD 的归因风险为 17669 例肝脏相关并发症（95% CI，66.0%-76.8%）、1599 例肝移植（95% CI，61.6%-72.4%）和 6677 例肝死亡（95% CI，63.4%-73.5%）的 71.8%（95% CI，66.0%-76.8%）。在观察期间，AUD 患者的肝移植数量保持稳定，而肝死亡数量增加的速度更快。
在法国，2008-2013 年，AUD 导致年轻和中年成年人慢性 HCV 感染负担的三分之二以上。
本研究跟踪了 97347 例 2008-2013 年期间法国医院出院的年轻和中年（18-65 岁）慢性 HCV 感染者的肝脏相关并发症和死亡率。约 30%的患者记录有酒精使用障碍（AUD），且发生肝脏相关并发症（即失代偿性肝硬化和肝癌）的可能性最高。在法国，2008-2013 年期间，AUD 导致 1599 例肝移植和 6677 例肝死亡，占慢性 HCV 感染者中记录的肝移植和肝死亡的三分之二以上。酒精康复和戒酒与肝脏相关并发症风险降低 50%以上相关。减少慢性 HCV 感染负担应高度重视促进酒精戒断。
