Clinical Epidemiology and EBM Unit, Beijing Friendship Hospital, Capital Medical University; Beijing Clinical Research Institute, Beijing, China.
Methodological Platform, National Clinical Research Center for Digestive Diseases, Beijing, China.
J Med Virol. 2024 Jan;96(1):e29405. doi: 10.1002/jmv.29405.
Liver cirrhosis remains a major health concern globally, but its epidemiology and etiology evolve with time. However, the changing pattern in etiology and cause of liver-related mortality for patients with cirrhosis are not fully elucidated. Herein, our aim was to characterize the temporal trend of the etiological spectrum and evaluate the impact of etiology on liver-related death among patients with compensated cirrhosis (CC) in Beijing, China. Clinical profiles of patients with CC discharged between January 2008 and December 2015 were retrieved from the Beijing hospital discharge database. The mortalities of different etiologies of cirrhosis were calculated. The risks of readmission and liver-related death associated with etiologies were evaluated by the Cox regression model. A total of 23 978 cirrhotic patients were included. The predominant cause was hepatitis B virus (HBV) (58.93%), followed by alcohol (21.35%), autoimmune (14.85%), miscellaneous etiologies (3.55%), and hepatitis C virus (HCV) (1.32%). From 2008 to 2015, the proportion of HBV-related cirrhosis decreased to 28.11%. Meanwhile, the proportions of autoimmune- and miscellaneous-related cirrhosis increased to 28.54% and 13.11%. The risk of liver-related death ranked the highest in patients with miscellaneous cirrhosis, followed by HBV-related cirrhosis, alcohol-related cirrhosis, autoimmune-related cirrhosis, and HCV-related cirrhosis. The 5-year rates of liver-related death were 22.56%, 18.99%, 18.77%, 16.01%, and 10.76%, respectively. HBV-related cirrhosis caused the highest risk of hepatocellular carcinoma (HCC)-related death, whereas alcohol- and miscellaneous-related cirrhosis caused higher risks of decompensation (DC)-related death than HBV-related cirrhosis, with hazard ratios of 1.35 (95% confidence interval [CI]: 1.24-1.48) and 1.20 (95% CI: 1.03-1.40), respectively. HBV remained a common cause of liver cirrhosis but gradually decreased. Mortality disparities existed in etiologies, with higher risks of HCC-related death in HBV-related cirrhosis, and DC-related death in alcohol- and miscellaneous-related cirrhosis.
肝硬化仍然是一个全球性的主要健康问题，但随着时间的推移，其流行病学和病因学也在发生变化。然而，肝硬化患者的病因和肝相关死亡率的变化模式尚不完全清楚。在此，我们旨在描述病因谱的时间趋势，并评估病因学对中国北京代偿性肝硬化（CC）患者肝相关死亡的影响。从北京医院出院数据库中检索了 2008 年 1 月至 2015 年 12 月期间出院的 CC 患者的临床资料。计算了不同病因肝硬化的死亡率。采用 Cox 回归模型评估病因与再入院和肝相关死亡风险的关系。共纳入 23978 例肝硬化患者。主要病因是乙型肝炎病毒（HBV）（58.93%），其次是酒精（21.35%）、自身免疫（14.85%）、其他病因（3.55%）和丙型肝炎病毒（HCV）（1.32%）。从 2008 年到 2015 年，HBV 相关肝硬化的比例下降至 28.11%。与此同时，自身免疫性和其他病因相关肝硬化的比例分别上升至 28.54%和 13.11%。肝相关死亡风险最高的是其他病因相关肝硬化患者，其次是 HBV 相关肝硬化、酒精相关肝硬化、自身免疫性相关肝硬化和 HCV 相关肝硬化。5 年肝相关死亡率分别为 22.56%、18.99%、18.77%、16.01%和 10.76%。HBV 相关肝硬化导致 HCC 相关死亡的风险最高，而酒精和其他病因相关肝硬化导致失代偿（DC）相关死亡的风险高于 HBV 相关肝硬化，风险比分别为 1.35（95%置信区间[CI]：1.24-1.48）和 1.20（95%CI：1.03-1.40）。HBV 仍然是肝硬化的常见病因，但逐渐减少。病因之间存在死亡率差异，HBV 相关肝硬化 HCC 相关死亡风险较高，酒精和其他病因相关肝硬化 DC 相关死亡风险较高。
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