Cause-specific mortality in patients with alcohol-related liver disease in Denmark: a population-based study

Kann, Anna Emilie; Jepsen, Peter; Madsen, Lone Galmstrup; West, Joe; Askgaard, Gro

Abstract

Background
Knowledge of the causes of death is essential to prevent premature death in alcohol-related liver disease (ALD). We examined cause-specific mortality, including death due to specific cancers, in 15 years after diagnosis of ALD.

Methods
We used nationwide health registries to identify patients diagnosed with ALD from 2002 to 2017 in Denmark and followed them for the underlying cause of death through 2019. We estimated the cause-specific mortality and investigated whether the cause-specific mortality differed by sex, age (<50, 50-59, and ≥60 years), ALD severity at diagnosis (decompensated cirrhosis, compensated cirrhosis, steatosis, and alcoholic hepatitis), and presence of diabetes.

Findings
The study included 23,385 patients with incident ALD. Patients had a median age of 58 years, 15,819 (68%) were men, and 15,358 (66%) had cirrhosis. During 111,532 person-years of follow-up, 15,692 (67%) died. Liver disease was the leading cause of death. In the first five years after ALD diagnosis, liver disease caused more than half of all deaths, and the 5-year risk of death due to liver disease was 25∙8% (95%CI: 25∙3-26∙4%). Beyond five years of ALD diagnosis, cancer, alcohol use disorder, and cardiovascular disease became more frequent. HCC was the dominant cause of cancer death, followed by lung cancer, with 10-year risks of 2∙5% (95%CI: 2∙3-2∙7%) and 1∙9% (95%CI: 1∙7-2∙1), respectively. The 10-year risk of death due to liver disease of 30% was similar for patients in all age groups and independent of sex and diabetes but three times higher for those with decompensated cirrhosis than steatosis.

Interpretation
Patients diagnosed with ALD were at high risk of dying from liver disease many years after diagnosis, irrespective of age and sex. Death due to specific cancers, including HCC, each contributed minimally to the total mortality in patients with ALD.

Citation

Kann, A. E., Jepsen, P., Madsen, L. G., West, J., & Askgaard, G. (2023). Cause-specific mortality in patients with alcohol-related liver disease in Denmark: a population-based study. The Lancet Gastroenterology & Hepatology, 8(11), 1028-1034. https://doi.org/10.1016/S2468-1253%2823%2900192-9

• Journal Article Type: Article
• Acceptance Date: Jun 15, 2023
• Online Publication Date: Aug 31, 2023
• Publication Date: Nov 1, 2023
• Deposit Date: Jul 17, 2023
• Publicly Available Date: Mar 1, 2024
• Journal: Lancet Gastroenterology and Hepatology
• Electronic ISSN: 2468-1253
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 8
• Issue: 11
• Pages: 1028-1034
• DOI: https://doi.org/10.1016/S2468-1253%2823%2900192-9
• Keywords: Gastroenterology; Hepatology
• Public URL: https://nottingham-repository.worktribe.com/output/23206014
• Publisher URL: https://www.thelancet.com/journals/langas/article/PIIS2468-1253(23)00192-9/fulltext