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
ARTICLE HIGHLIGHTS
Research background

Liver cirrhosis (LC) is the end stage of chronic liver disease and is associated with significant morbidity, mortality and healthcare utilization. China accounts for a large proportion of the regional burden of LC. Thanks to widespread hepatitis B virus (HBV) vaccination and the potent antiviral treatment for HBV and hepatitis C virus, the LC mortality has greatly decreased.

Research motivation

In the context of changing burden of LC, the recent transition in etiologies and clinical features of LC is unclear in China.

Research objectives

Our main objective was to identify the transition in etiologies and clinical characteristics of hospitalized LC patients in Southern China. Furthermore, in-hospital prognosis and associated risk factors were also investigated.

Research methods

We included LC inpatients admitted from 2001 to 2020 in this retrospective, cross-sectional study. 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. 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.

Research results

The study included a total of 33143 patients and the mean age increased from 51.0 years in 2001-2010 to 52.0 years in 2011-2020 (P < 0.001). In the meantime, proportion of decompensated LC and the score of model for end-stage liver disease decreased. During the study period, HBV remained the major etiology of LC (75.0%), but the proportion of HBV-LC decreased from 82.4% in 2001-2005 to 74.2% in 2016-2020 (P for trend < 0.001). Meanwhile, the proportions of LC caused by alcoholic liver disease and autoimmune hepatitis both increased slightly (both P for trend < 0.001). In-hospital mortality was low, and HCC and ACLF were associated with 6-fold and 4-fold increased risks of mortality.

Research conclusions

Our study showed a decreased ratio of HBV LC, and an increased ratio of alcoholic and autoimmune hepatitis LC in real-world inpatients over the past two decades. HCC and ACLF were identified as the strongest risk factors for in-hospital mortality.

Research perspectives

Our large sample cross-sectional study showed the transition in etiologies and characteristics of newly diagnosed LC in our medical center over the past twenty years and the findings may reflect the changing trend of LC in entire Southern China. Future multicenter studies are needed to reveal the changing incidence of LC in China, and more attention should be given to the rising burden of HCC and ACLF in LC patients.