Clinical and Translational Research
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 27, 2023; 15(12): 1294-1306
Published online Dec 27, 2023. doi: 10.4254/wjh.v15.i12.1294
Study of liver cirrhosis over twenty consecutive years in adults in Southern China
Xing Wang, Jin-Ni Luo, Xiao-Ying Wu, Qi-Xian Zhang, Bin Wu
Xing Wang, Jin-Ni Luo, Xiao-Ying Wu, Bin Wu, Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
Xing Wang, Jin-Ni Luo, Xiao-Ying Wu, Bin Wu, Guangdong Provincial Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
Qi-Xian Zhang, Patient Case Management Division, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
Co-first authors: Xing Wang and Jin-Ni Luo.
Author contributions: Wang X, Luo JN, Wu XY and Wu B planned and designed the study; Wang X, Luo JN, Wu XY and Zhang QX collected the data; Wang X and Luo JN performed the data analysis; Wang X and Luo JN drafted the manuscript; Wu B critically revised the manuscript; all authors have approved the submitted manuscript. Wang X and Luo JN contributed equally to this work as co-first authors. Wang X and Luo JN are designated as co-first authors due to their equal and substantial contributions to the study conception, design, data acquisition, and data analysis, as well as manuscript preparation and editing, each playing pivotal roles in ensuring the integrity and quality of the research.
Supported by National Natural Science Foundation of China, No. 82070574; Natural Science Foundation of Guangdong Province Team Project, No. 2018B030312009.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Third Affiliated Hospital of Sun Yat-sen University and carried out in compliance with the Declaration of Helsinki.
Informed consent statement: As the study used anonymous and pre-existing data, the requirement for the informed consent from patients was waived.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: All data relevant to the study have been included in the article or uploaded as Supplementary Table 1. The dataset for this study is available from the corresponding author on reasonable request and fulfilment of regulatory requirements.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bin Wu, PhD, Professor, Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou 510630, Guangdong Province, China. wubin6@mail.sysu.edu.cn
Received: September 6, 2023
Peer-review started: September 6, 2023
First decision: October 25, 2023
Revised: November 7, 2023
Accepted: November 24, 2023
Article in press: November 24, 2023
Published online: December 27, 2023
Processing time: 109 Days and 18.3 Hours
Abstract
BACKGROUND

Liver cirrhosis (LC) is a prevalent and severe disease in China. The burden of LC is changing with widespread vaccination of hepatitis B virus (HBV) and antiviral therapy. However, the recent transition in etiologies and clinical features of LC cases requiring hospitalization is unclear.

AIM

To identify the transition in etiologies and clinical characteristics of hospitalized LC patients in Southern China.

METHODS

In this retrospective, cross-sectional study we included LC inpatients admitted between January 2001 and December 2020. Medical data indicating etiological diagnosis and LC complications, and demographic, laboratory, and imaging data were collected from our hospital-based dataset. The etiologies of LC were mainly determined according to the discharge diagnosis, and upper gastrointestinal bleeding, ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, hepatocellular carcinoma (HCC), portal vein thrombosis, hepatorenal syndrome, and acute-on-chronic liver failure (ACLF) were considered LC-related complications in our study. Changing trends in the etiologies and clinical characteristics were investigated using logistic regression, and temporal trends in proportions of separated years were investigated using the Cochran-Armitage test. In-hospital prognosis and risk factors associated with in-hospital mortality were also investigated.

RESULTS

A total of 33143 patients were included in the study [mean (SD) age, 51.7 (11.9) years], and 82.2% were males. The mean age of the study population increased from 51.0 years in 2001-2010 to 52.0 years in 2011-2020 (P < 0.001), and the proportion of female patients increased from 16.7% in 2001-2010 to 18.2% in 2011-2020 (P = 0.003). LC patients in the decompensated stage at diagnosis decreased from 68.1% in 2001-2010 to 64.6% in 2011-2020 (P < 0.001), and the median score of model for end-stage liver disease also decreased from 14.0 to 11.0 (P < 0.001). HBV remained the major etiology of LC (75.0%) and the dominant cause of viral hepatitis-LC (94.5%) during the study period. However, the proportion of HBV-LC decreased from 82.4% in 2001-2005 to 74.2% in 2016-2020, and the proportion of viral hepatitis-LC decreased from 85.2% in 2001-2005 to 78.1% in 2016-2020 (both P for trend < 0.001). Meanwhile, the proportions of LC caused by alcoholic liver disease, autoimmune hepatitis and mixed etiology increased by 2.5%, 0.8% and 4.5%, respectively (all P for trend < 0.001). In-hospital mortality was stable at 1.0% in 2011-2020, whereas HCC and ACLF manifested the highest increases in prevalence among all LC complications (35.8% to 41.0% and 5.7% to 12.4%, respectively) and were associated with 6-fold and 4-fold increased risks of mortality (odds ratios: 6.03 and 4.22, respectively).

CONCLUSION

LC inpatients have experienced changes in age distribution and etiologies of cirrhosis over the last 20 years in Southern China. HCC and ACLF are associated with the highest risk of in-hospital mortality among LC complications.

Keywords: Liver cirrhosis; Epidemiology; Etiology; Upper gastrointestinal bleeding; Hepatocellular carcinoma; In-hospital mortality

Core Tip: The etiologies and clinical characteristics of liver cirrhosis (LC) in hospitalized patients changed during the 2001-2020 period in Southern China. The mean age and female proportion have increased but the disease severity at LC diagnosis has alleviated over time. The proportion of hepatitis B virus-LC has decreased, while proportions of LC caused by alcoholic liver disease, autoimmune hepatitis and mixed etiology have increased gradually. Among all complications of LC, hepatocellular carcinoma and acute-on-chronic liver failure manifest the highest increase in prevalence and are associated with the highest risk of in-hospital mortality.