Hagström Hannes, Thiele Maja, Roelstraete Bjorn, Söderling Jonas, Ludvigsson Jonas F
Division of Hepatology, Department of Upper GI, Karolinska University Hospital, Stockholm, Sweden
Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
Gut. 2021 Jan;70(1):170-179. doi: 10.1136/gutjnl-2019-320446. Epub 2020 Mar 27.
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.
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.
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).
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.
酒精性肝病（ALD）患者的死亡风险增加，但很少有研究调查与普通人群相比组织学严重程度的意义或估计相对风险。我们在全国范围内对经活检证实的ALD队列进行了死亡率研究。
瑞典基于人群的队列研究，比较了1969年至2017年期间3453名有ALD国际疾病分类（ICD）编码且进行了肝活检的个体与16535名匹配的普通人群个体。使用瑞典国家登记册确定总体和疾病特异性死亡率，随访从首次ICD诊断或肝活检最晚时间加3个月开始。采用Cox回归对相关混杂因素进行调整，以估计ALD和组织病理学亚组中的风险比（HR）。
诊断时的中位年龄为58岁，65%为男性，52%在基线时有肝硬化。ALD患者的5年累积死亡率为40.9%，而对照个体为5.8%。总体死亡风险显著增加（调整后HR（aHR）=4.70，95%CI 4.35至5.08）。肝脏相关死亡风险尤其高（占所有死亡的43%，aHR=167.6，95%CI 101.7至276.3）。无肝硬化的ALD患者死亡率也显著增加，在基线后第一年最高，但在随访≥10年后仍持续存在（aHR=2.74，95%CI 2.37至3.16）。
经活检证实的ALD个体的死亡风险比普通人群增加近五倍。无肝硬化的ALD个体死亡风险也增加，再次强调需要加强对这些个体管理的警惕性。
