Cirrhosis etiology trends in developing countries: Transition from infectious to metabolic conditions. Report from a multicentric cohort in central Mexico.

作者信息

Gonzalez-Chagolla Alex, Olivas-Martinez Antonio, Ruiz-Manriquez Jesus, Servín-Rojas Maximiliano, Kauffman-Ortega Eric, Chávez-García Luis Carlos, Juárez-León Oscar, Cordova-Gallardo Jacqueline, Díaz-García Juan Daniel, Gonzalez-Huezo Maria Sarai, Milanés-Lizarraga Guadalupe, Paez-Zayas Victor M, Castillo-Barradas Mauricio, Cobos-Quevedo Orestes de Jesús, García-Juárez Francisco Isaí, Romero-Lozanía José Alberto, Toapanta-Yanchapaxi Liz, Sánchez-Avila Juan Francisco, Avila-Rojo José Alonso, Bonilla-Salas Aliberth, Dirthurbide-Hernández Michelle, Ruiz Isaac, Valenzuela-Vidales Ana K, García-Juárez Ignacio

机构信息

Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.

Department of Biostatistics, University of Washington, Seattle, WA, United States.

出版信息

Lancet Reg Health Am. 2021 Dec 21;7:100151. doi: 10.1016/j.lana.2021.100151. eCollection 2022 Mar.

DOI:10.1016/j.lana.2021.100151

PMID:36777654

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9904121/

Abstract

BACKGROUND

Cirrhosis is a public health threat associated with high mortality. Alcoholic Liver Disease (ALD) is the leading cause in Latin America and Metabolic Associated Fatty Liver Disease (MAFLD) in western countries. In Mexico, ALD and chronic Hepatitis C Virus infection (HCV) were the most frequent aetiologies during the past decades. We aimed to describe the trends in the aetiologies of cirrhosis in a middle-income country.

METHODS

We performed a retrospective cohort study including patients diagnosed with cirrhosis between 2000 and 2019 from six different tertiary care hospitals in central Mexico. We collected information regarding cirrhosis etiology, year of diagnosis, hepatocellular carcinoma development, liver transplantation, and death. We illustrated the change in the tendencies of cirrhosis aetiologies by displaying the proportional incidence of each etiology over time stratified by age and gender, and we compared these proportions over time using chi square tests.

FINDINGS

Overall, 4,584 patients were included. In 2019, MAFLD was the most frequent cirrhosis etiology (30%), followed by ALD (24%) and HCV (23%). During the study period, MAFLD became the leading etiology, ALD remained second, and HCV passed from first to fourth. When analysed by gender, ALD was the leading etiology for men and MAFLD for women. The annual incidence of HCC was 3·84 cases/100 persons-year, the median survival after diagnosis was 12·1 years, and seven percent underwent LT.

INTERPRETATION

Increased alcohol consumption and the obesity epidemic have caused a transition in the aetiologies of cirrhosis in Mexico. Public health policies must be tailored accordingly to mitigate the burden of alcohol and metabolic conditions in developing countries.