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., …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