Björnsson E S, Johannsson A, Sigurdarson S S, Hreinsson J P, Runarsdottir V
Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Divison of Gastroenterology, Landspitali University Hospital, Reykjavik, Iceland.
Scand J Gastroenterol. 2023 Jul-Dec;58(12):1523-1533. doi: 10.1080/00365521.2023.2245939. Epub 2023 Aug 8.
Limited data exist on the association between alcohol consumption and incidence of alcohol related liver disease (ARLD). The aims were to analyse this relationship and assess prevalence of ARLD in Iceland and among patients treated for alcohol use disorder (AUD) and its impact on outcomes.
A retrospective study on all patients diagnosed with severe ARLD: alcohol related cirrhosis (ARC) and alcohol related hepatitis (ARH) in Iceland 1984-2020. Medical records were scrutinized for clinical features, severity of ARLD, proportion undergoing treatment for AUD, data on abstinence and long-term outcomes.
A total of 314 patients, males 76%, median age 56 years, fulfilled the predetermined criteria for ARLD. Median MELD was 17, 73% with Child-Pugh B/C and 70/314 (22%) who had ARH. Incidence of ARLD increased from 0.77 cases per 100 000 inhabitants annually 1984-2000 to 6.1 per 100 000 in 2016-2020. alcohol consumption increased from 4.3 Liters to 7.5 L in in the same time periods. Overall 220/314 (70%) with ARLD had undergone treatment for AUD. Of all individuals who had AUD treatment during the study period ( = 21.845), 1% were diagnosed with ARLD. Patients who underwent treatment for AUD after the ARLD diagnosis had better prognosis than those who had treatment prior to ARLD diagnosis (hazard ratio 2.5 [95% CI 1.3-5.0]).
The incidence of ARLD increased 8-fold during the study period coinciding with 74% increase in alcohol consumption. Patients with prior diagnosis of AUD had worse prognosis that needs special attention.
关于饮酒与酒精性肝病（ARLD）发病率之间关联的数据有限。本研究旨在分析这种关系，并评估冰岛以及酒精使用障碍（AUD）患者中ARLD的患病率及其对预后的影响。
对1984年至2020年期间冰岛所有被诊断为重度ARLD（酒精性肝硬化（ARC）和酒精性肝炎（ARH））的患者进行回顾性研究。仔细审查病历以获取临床特征、ARLD的严重程度、接受AUD治疗的比例、戒酒数据和长期预后。
共有314例患者符合ARLD的预定标准，其中男性占76%，中位年龄56岁。中位终末期肝病模型（MELD）评分为17，73%的患者为Child-Pugh B/C级，70/314（22%）的患者患有ARH。ARLD的发病率从1984年至2000年每年每10万居民0.77例增加到2016年至2020年的每10万居民6.1例。同期酒精消费量从4.3升增加到7.5升。总体而言，220/314（70%）的ARLD患者接受过AUD治疗。在研究期间接受AUD治疗的所有个体（n = 21,845）中，1%被诊断为ARLD。ARLD诊断后接受AUD治疗的患者预后优于ARLD诊断前接受治疗的患者（风险比2.5 [95%置信区间1.3 - 5.0]）。
在研究期间，ARLD的发病率增加了8倍，与此同时酒精消费量增加了74%。先前诊断为AUD的患者预后较差，需要特别关注。
