Risk For Alcoholic Cirrhosis After First Alcohol-Related Hospital Contact

With half of all deaths from cirrhosis attributable to alcohol, understanding the risk for alcoholic cirrhosis after an initial hospital contact related to alcohol use may bolster prevention efforts. Investigators examined data from patients with alcohol intoxication or alcohol use disorder diagnoses in a nationwide registry of hospital admissions and outpatient (including emergency) visits in Denmark between 1998 and 2002. They then followed the cohort in these retrospective data through 2014 for the development of alcoholic cirrhosis.

• Among 36,044 adults with an initial contact (half of whom had an inpatient admission), the 15-year absolute risk of alcoholic cirrhosis was 6% for men and 5% for women; risks at 5 years were 2.6% and 2.3%, respectively.
• The incidence rate was 11 times higher for men and 18 times higher for women than the rate in the general population.
• The highest risk was for those aged 40–59 years at their initial contact (compared with those older or younger), and for those with a disorder (compared with intoxication).

Comments: This study counted outpatient and emergency care as well as hospitalizations as “hospital contact,” which means they are actually visits to a hospital system not limited to acute care overnight stays. Nonetheless, the data provide a window into the risk for alcoholic cirrhosis among those who drink so much that it prompts a healthcare visit. Although there are many reasons to offer effective care to people who obtain healthcare, the idea that 1 in 20 will have cirrhosis in 10–15 years could spur patients and physicians alike to engage in effective medical treatment to prevent it.

Richard Saitz, MD, MPH

Reference: Askgaard G, Leon DA, Kjaer MS, et al. Risk for alcoholic liver cirrhosis after initial hospital contact with alcohol problems: a nationwide prospective cohort study. Hepatology. 2017;65(3):929–937.