Alcohol-related liver disease, alone or in combination with other etiologies, is more likely to be diagnosed at later stages than liver disease with other causes, according to a recent study.
Researchers performed a cross-sectional analysis of patients with early or advanced liver disease at 17 tertiary care liver or GI units worldwide from August 2015 through March 2017. Data were collected on anthropometric, etiologic, and clinical variables. Model for End-Stage Liver Disease (MELD) scores were also determined. The primary outcome was odds of evaluation at a late disease stage. Results of the study were published Jan. 29 by Clinical Gastroenterology and Hepatology.
Overall, 3,453 consecutive patients were included in the study, 1,699 with early liver disease and 1,754 with advanced liver disease. In the 2,793 patients with one cause of liver disease, 29.5% had hepatitis C virus (HCV) infection, 20.5% had alcohol-related liver disease, 18.7% had hepatitis B virus (HBV) infection, 14.6% had nonalcoholic fatty liver disease (NAFLD). Eleven percent of patients with alcohol-related liver disease were seen at early stages, and most were seen at advanced stages versus HCV patients (odds ratio, 10.5; P=0.001). Of patients with one cause of liver disease who were seen at an advanced stage, 29% had alcohol-related liver disease. Patients in this group with alcohol-related liver disease were also more likely to present with more complications and with more severe disease than those with liver disease of other causes.
Six hundred sixty patients had more than one cause of liver disease at presentation. Among those with two causes, 22.6% had HCV- and alcohol-related liver disease, 17.5% had NAFLD and alcohol-related liver disease, 13.6% had HCV-related liver disease and NAFLD, 7.9% had HBV- and alcohol-related liver disease, and 38.4% had other combinations. Odds ratios for advanced versus early medical visits compared to HCV were 5.6 for patients with HCV- and alcohol-related disease, 5.0 for patients with NAFLD and alcohol-related disease, and 6.5 for patients with HBV- and alcohol-related disease.
The researchers noted that their study was retrospective and that tertiary care centers may see more patients with advanced disease than general hospitals, among other limitations. However, they concluded that patients who have alcohol-related liver disease are less likely to be seen at early stages than those whose disease is related to viral hepatitis or NAFLD, due in part to the development of effective drugs for the former and increased awareness of the latter. “Programs aimed at early identification and specialized centers' medical visits of [alcohol-related liver disease] are urgently needed at a global level,” the researchers wrote.