Extra‐hepatic Morbidity and Mortality in Alcohol‐related Liver Disease: Systematic Review and Meta‐analysis

Theodoreson, Mark D.; Aithal, Guruprasad P.; Allison, Michael; Brahmania, Mayur; Forrest, Ewan; Hagström, Hannes; Johansen, Stine; Krag, Aleksander; Likhitsup, Alisa; Masson, Steven; McCune, Anne; Rajoriya, Neil; Thiele, Maja; Rowe, Ian A.; Parker, Richard

Abstract

Background
Alcohol use increases the risk of many conditions in addition to liver disease; patients with alcohol-related liver disease (ALD) are therefore at risk from both extra-hepatic and hepatic disease.

Aims
This review synthesises information about non-liver-related mortality in persons with ALD.

Methods
A systematic literature review was performed to identify studies describing non-liver outcomes in ALD. Information about overall non-liver mortality was extracted from included studies and sub-categorised into major causes: cardiovascular disease (CVD), non-liver cancer and infection. Single-proportion meta-analysis was done to calculate incidence rates (events/1000 patient-years) and relative risks (RR) compared with control populations.

Results
Thirty-seven studies describing 50 302 individuals with 155 820 patient-years of follow-up were included. Diabetes, CVD and obesity were highly prevalent amongst included patients (5.4%, 10.4% and 20.8% respectively). Outcomes varied across the spectrum of ALD: in alcohol-related fatty liver the rate of non-liver mortality was 43.4/1000 patient-years, whereas in alcoholic hepatitis the rate of non-liver mortality was 22.5/1000 patient-years. The risk of all studied outcomes was higher in ALD compared with control populations: The RR of death from CVD was 2.4 (1.6–3.8), from non-hepatic cancer 2.2 (1.6–2.9) and from infection 8.2 (4.7–14.3).

Conclusion
Persons with ALD are at high risk of death from non-liver causes such as cardiovascular disease and non-hepatic cancer.

Citation

Theodoreson, M. D., Aithal, G. P., Allison, M., Brahmania, M., Forrest, E., Hagström, H., Johansen, S., Krag, A., Likhitsup, A., Masson, S., McCune, A., Rajoriya, N., Thiele, M., Rowe, I. A., & Parker, R. (2023). Extra‐hepatic Morbidity and Mortality in Alcohol‐related Liver Disease: Systematic Review and Meta‐analysis. Liver International, 43(4), 763-772. https://doi.org/10.1111/liv.15526

• Journal Article Type: Article
• Acceptance Date: Jan 18, 2023
• Online Publication Date: Jan 24, 2023
• Publication Date: Apr 1, 2023
• Deposit Date: Jul 19, 2023
• Publicly Available Date: Jan 25, 2024
• Journal: Liver International
• Print ISSN: 1478-3223
• Electronic ISSN: 1478-3231
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 43
• Issue: 4
• Pages: 763-772
• DOI: https://doi.org/10.1111/liv.15526
• Keywords: Hepatology
• Public URL: https://nottingham-repository.worktribe.com/output/16506880
• Publisher URL: https://onlinelibrary.wiley.com/doi/10.1111/liv.15526