Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, China.
State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.
BMC Gastroenterol. 2020 Apr 29;20(1):128. doi: 10.1186/s12876-020-01277-0.
Because of high-risk behaviours, sedentary lifestyle and side effects of medications, psychiatric patients are at risk of viral hepatitis, alcohol-related liver disease and non-alcoholic fatty liver disease. We aimed to study the incidence of hepatocellular carcinoma (HCC) and cirrhotic complications in psychiatric patients.
We identified consecutive adult patients in all public hospitals and clinics in Hong Kong with psychiatric diagnoses between year 2003 and 2007 using the Clinical Data Analysis and Reporting System, which represents in-patient and out-patient data of approximately 80% of the 7.4-million local population. The patients were followed for liver-related events (HCC and cirrhotic complications) and deaths until December 2017. Age- and sex-standardized incidence ratio (SIR) of HCC in psychiatric patients to the general population was estimated by Poisson model.
We included 105,763 psychiatric patients without prior liver-related events in the final analysis. During a median (interquartile range) follow-up of 12.4 (11.0-13.7) years, 1461 (1.4%) patients developed liver-related events; 472 (0.4%) patients developed HCC. Compared with the general population, psychiatric patients had increased incidence of HCC (SIR 1.42, 95% confidence interval [CI] 1.28-1.57, P < 0.001). The SIR was highest in patients with drug-induced (SIR 3.18, 95% CI 2.41-4.11, P < 0.001) and alcohol-induced mental disorders (SIR 2.98, 95% CI 2.30-3.81, P < 0.001), but was also increased in patients with psychotic disorders (SIR 1.39, 95% CI 1.16-1.65, P < 0.001) and mood disorders (SIR 1.16, 95% CI 1.00-1.34, P = 0.047). Liver disease was the fifth most common cause of death in this population, accounting for 595 of 10,614 (5.6%) deaths. Importantly, 569 (38.9%) patients were not known to have liver diseases at the time of liver-related events. The median age at HCC diagnosis (61 [range 26-83] years) was older and the median overall survival (8.0 [95% CI 5.0-10.9] months) after HCC diagnosis was shorter in this cohort of psychiatric patients than other reports from Hong Kong.
HCC, cirrhotic complications, and liver-related deaths are common in psychiatric patients, but liver diseases are often undiagnosed. More efforts are needed to identify liver diseases in the psychiatric population so that treatments and screening for HCC and varices can be provided to patients in need.
由于高危行为、久坐的生活方式和药物的副作用，精神科患者有患病毒性肝炎、酒精性肝病和非酒精性脂肪性肝病的风险。我们旨在研究精神科患者肝细胞癌（HCC）和肝硬化并发症的发病率。
我们使用临床数据分析和报告系统在香港所有公立医院和诊所中确定了 2003 年至 2007 年期间连续的成年精神科患者，该系统代表了约 740 万本地人口的 80%左右的住院和门诊数据。对这些患者进行了与肝脏相关的事件（HCC 和肝硬化并发症）和死亡的随访，直到 2017 年 12 月。通过泊松模型估计精神科患者 HCC 的年龄和性别标准化发病率比（SIR）与普通人群相比。
我们在最终分析中纳入了 105763 名没有先前肝脏相关事件的精神科患者。在中位（四分位间距）12.4 年（11.0-13.7 年）的随访中，1461 名（1.4%）患者发生了肝脏相关事件；472 名（0.4%）患者发生了 HCC。与普通人群相比，精神科患者 HCC 的发病率较高（SIR 1.42，95%CI 1.28-1.57，P<0.001）。药物性（SIR 3.18，95%CI 2.41-4.11，P<0.001）和酒精性精神障碍（SIR 2.98，95%CI 2.30-3.81，P<0.001）患者的 SIR 最高，但精神病障碍（SIR 1.39，95%CI 1.16-1.65，P<0.001）和情绪障碍（SIR 1.16，95%CI 1.00-1.34，P=0.047）患者的 SIR 也有所增加。在该人群中，肝脏疾病是第五大常见死亡原因，占 10614 例死亡中的 595 例（5.6%）。重要的是，在发生肝脏相关事件时，569 名（38.9%）患者的肝脏疾病未被发现。该队列中 HCC 诊断的中位年龄（61 岁[范围 26-83 岁]）较香港其他报告的年龄更大，HCC 诊断后总生存期（8.0 [95%CI 5.0-10.9] 个月）较短。
HCC、肝硬化并发症和与肝脏相关的死亡在精神科患者中很常见，但肝脏疾病往往未被诊断。需要进一步努力识别精神科人群中的肝脏疾病，以便为有需要的患者提供 HCC 和静脉曲张的治疗和筛查。
