Alcohol-Related Liver Disease Is Rarely Detected at Early Stages Compared With Liver Diseases of Other Etiologies Worldwide
Neil D Shah 1 , Meritxell Ventura-Cots 2 , Juan G Abraldes 3 , Mohamed Alboraie 4 , Ahmad Alfadhli 5 , Josepmaria Argemi 6 , Ester Badia-Aranda 7 , Enrique Arús-Soler 8 , A Sidney Barritt 4th 1 , Fernando Bessone 9 , Marina Biryukova 10 , Flair J Carrilho 11 , Marlen Castellanos Fernández 8 , Zaily Dorta Guiridi 10 , Mohamed El Kassas 12 , Teo Eng-Kiong 13 , Alberto Queiroz Farias 11 , Jacob George 14 , Wenfang Gui 15 , Prem H Thurairajah 13 , John Chen Hsiang 13 , Azra Husić-Selimovic 16 , Vasily Isakov 10 , Mercy Karoney 17 , Won Kim 18 , Johannes Kluwe 19 , Rakesh Kochhar 20 , Narendra Dhaka 20 , Pedro Marques Costa 21 , Mariana A Nabeshima Pharm 11 , Suzane K Ono 11 , Daniela Reis 21 , Agustina Rodil 11 , Caridad Ruenes Domech 8 , Federico Sáez-Royuela 7 , Christoph Scheurich 19 , Way Siow 14 , Nadja Sivac-Burina 16 , Edna Solange Dos Santos Traquino 8 , Fatma Some 17 , Sanjin Spreckic 16 , Shiyun Tan 22 , Julio Vorobioff 9 , Andrew Wandera 17 , Pengbo Wu 22 , Mohamed Yacoub 23 , Ling Yang 15 , Yuanjie Yu 22 , Nerma Zahiragic 16 , Chaoqun Zhang 22 , Helena Cortez-Pinto 21 , Ramon Bataller 24
Background & aims: Despite recent advances in treatment of viral hepatitis, liver-related mortality is high, possibly owing to the large burden of advanced alcohol-related liver disease (ALD). We investigated whether patients with ALD are initially seen at later stages of disease development than patients with hepatitis C virus (HCV) infection or other etiologies.
Methods: We performed a cross-sectional study of 3453 consecutive patients with either early or advanced liver disease (1699 patients with early and 1754 with advanced liver disease) seen at 17 tertiary care liver or gastrointestinal units worldwide, from August 2015 through March 2017. We collected anthropometric, etiology, and clinical information, as well as and model for end-stage liver disease scores. We used unconditional logistic regression to estimate the odds ratios for evaluation at late stages of the disease progression.
Results: Of the patients analyzed, 81% had 1 etiology of liver disease and 17% had 2 etiologies of liver disease. Of patients seen at early stages for a single etiology, 31% had HCV infection, 21% had hepatitis B virus infection, and 17% had nonalcoholic fatty liver disease, whereas only 3.8% had ALD. In contrast, 29% of patients seen for advanced disease had ALD. Patients with ALD were more likely to be seen at specialized centers, with advanced-stage disease, compared with patients with HCV-associated liver disease (odds ratio, 14.1; 95% CI, 10.5-18.9; P < .001). Of patients with 2 etiologies of liver disease, excess alcohol use was associated with 50% of cases. These patients had significantly more visits to health care providers, with more advanced disease, compared with patients without excess alcohol use. The mean model for end-stage liver disease score for patients with advanced ALD (score, 16) was higher than for patients with advanced liver disease not associated with excess alcohol use (score, 13) (P < .01).
Conclusions: In a cross-sectional analysis of patients with liver disease worldwide, we found that patients with ALD are seen with more advanced-stage disease than patients with HCV-associated liver disease. Of patients with 2 etiologies of liver disease, excess alcohol use was associated with 50% of cases. Early detection and referral programs are needed for patients with ALD worldwide.