School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Department of Hepatology, Sir Charles Gairdner Hospital, Perth, Australia.
Department of Biochemistry, PathWest Laboratory Medicine, Perth, Australia.
Clin Gastroenterol Hepatol. 2020 Feb;18(2):496-504.e3. doi: 10.1016/j.cgh.2019.07.013. Epub 2019 Jul 15.
BACKGROUND & AIMS: Chronic liver disease is a major health burden that produces significant liver-related morbidity and mortality. We aimed to evaluate liver-related outcomes of patients with different causes of chronic liver disease in Australia.
We collected data from 10,933 patients with chronic liver disease assessed by Hepascore (a serum fibrosis model) in Western Australia from 2004 through 2015. We obtained records of liver-related death, transplantation, decompensation, and hepatocellular carcinoma from WA Data Linkage Unit databases. Competing risk analysis was used to calculate the cumulative risk of each clinical endpoint, and risks for clinical endpoints were compared among all causes of chronic liver disease.
In our final cohort for analysis, 5566 patients had hepatitis C virus (HCV) infection, 1989 had HBV infection, 119 were infected with HBV and HCV, 955 had alcohol-associated liver disease, 1597 had non-alcoholic fatty liver disease (NAFLD), 123 had alcohol-associated liver disease and metabolic risk factors, 561 had autoimmune liver disease without overlap syndrome, and 23 autoimmune overlap syndrome. Significant differences among chronic liver diseases were observed in risk of all-cause death (P < .001), liver-related death (P < .001), liver transplantation (P < .001), and decompensation (P < .001) but not hepatocellular carcinoma (P=.095). Patients with alcohol-associated liver disease had the highest 5-year cumulative risk of liver-related death (17.1%) and the second-highest 5-year cumulative risk of decompensation (29.2%). Multivariate analysis found patients with alcohol-associated liver disease had significantly higher risks of liver-related death and decompensation than patients with HCV infection with hazard ratios (HRs) of 2.39 (95% CI, 1.88-3.03) and 3.42 (95% CI, 2.74-4.27), respectively. Patients with NAFLD had a significantly lower risk of liver related death and decompensation than patients with HCV infection, with HRs of 0.67 (95% CI, 0.48-0.95) and 0.70 (95% CI, 0.52-0.94) respectively.
In an analysis of patients in Western Australia, we found patients with alcohol-associated liver disease to have significantly higher risk of decompensation and liver-related death than patients with HCV infection, whereas patients with NAFLD have significantly lower risks of either outcome.
慢性肝病是一个重大的健康负担，会导致显著的肝脏相关发病率和死亡率。我们旨在评估澳大利亚不同病因慢性肝病患者的肝脏相关结局。
我们收集了 2004 年至 2015 年间西澳大利亚州通过 Hepascore（一种血清纤维化模型）评估的 10933 例慢性肝病患者的数据。我们从西澳大利亚州数据链接单元数据库中获得了与肝脏相关的死亡、移植、失代偿和肝细胞癌的记录。使用竞争风险分析计算每个临床终点的累积风险，并比较所有慢性肝病病因的临床终点风险。
在我们最终的分析队列中，5566 例患者患有丙型肝炎病毒（HCV）感染，1989 例患有乙型肝炎病毒（HBV）感染，119 例同时感染 HBV 和 HCV，955 例患有酒精性肝病，1597 例患有非酒精性脂肪性肝病（NAFLD），123 例患有酒精性肝病和代谢危险因素，561 例患有自身免疫性肝病无重叠综合征，23 例患有自身免疫重叠综合征。在全因死亡（P <.001）、肝脏相关死亡（P <.001）、肝移植（P <.001）和失代偿（P <.001）方面，不同慢性肝病之间存在显著差异，但肝细胞癌（P=.095）除外。酒精性肝病患者的 5 年累积肝脏相关死亡风险最高（17.1%），5 年累积失代偿风险第二高（29.2%）。多变量分析发现，与 HCV 感染患者相比，酒精性肝病患者的肝脏相关死亡和失代偿风险显著更高，风险比（HR）分别为 2.39（95%CI，1.88-3.03）和 3.42（95%CI，2.74-4.27）。与 HCV 感染患者相比，NAFLD 患者的肝脏相关死亡和失代偿风险显著降低，HR 分别为 0.67（95%CI，0.48-0.95）和 0.70（95%CI，0.52-0.94）。
在对西澳大利亚州患者的分析中，我们发现与 HCV 感染患者相比，酒精性肝病患者的失代偿和肝脏相关死亡风险显著更高，而 NAFLD 患者的这两种结局风险显著更低。
