Study of liver cirrhosis over twenty consecutive years in adults in Southern China

Table 1 Transition in characteristics of the study population over 20 years

Characteristic	Total population, n = 33143	2001-2010, n = 7993	2011-2020, n = 25150	P value
Age (yr, mean ± SD)	51.7 (11.9)	51.0 (12.3)	52.0 (11.8)	< 0.001
Gender (male, %)	27237 (82.2)	6658 (83.3)	20579 (81.8)	0.003
Laboratory test (mean ± SD)
Albumin (g/L)	34.1 (6.3)	33.4 (6.4)	34.2 (6.2)	< 0.001
Bilirubin (umol/L)	87.7 (139.4)	98.3 (148.9)	85.4 (137.1)	< 0.001
Prothrombin INR	1.45 (0.65)	1.53 (0.65)	1.44 (0.65)	< 0.001
MELD score (Median, IQR)	12.0 (8.0,18.0)	14.0 (10.0, 19.0)	11.0 (8.0,18.0)	< 0.001
Decompensation1 (n,%)	21701 (65.5)	5443 (68.1)	16258 (64.6)	< 0.001
Complications
UGIB	4729 (14.3)	998 (12.5)	3731 (14.8)	< 0.001
Ascites	16656 (50.3)	4444 (55.6)	12212 (48.6)	< 0.001
HE	1901 (5.7)	535 (6.7)	1366 (5.4)	0.007
HCC	12159 (36.7)	2392 (29.9)	9767 (38.8)	< 0.001
PVT	2449 (7.4)	403 (5.0)	2046 (8.1)	< 0.001
HRS	713 (2.2)	291 (3.6)	422 (1.7)	< 0.001

¹Presence of any one of ascites, variceal bleeding, hepatic encephalopathy, or jaundice (total bilirubin > 51.3 umol/L). INR: International normalized ratio; MELD: Model for end-stage liver disease; IQR: Interquartile range; UGIB: Upper gastrointestinal bleeding; HE: Hepatic encephalopathy; HCC: Hepatocellular carcinoma; PVT: Portal vein thrombosis; HRS: Hepatic renal syndrome.

Table 2 Transition in etiological proportions over 20 years, n (%)

Etiology	2001-2005, n = 2870	2006-2010, n = 5123	2011-2015, n = 10538	2016-2020, n = 14612	P value1	P value2
Viral hepatitis	2444 (85.2)	4046 (79.0)	8385 (79.6)	11418 (78.1)	< 0.001	0.780
HBV	2366 (82.4)	3852 (75.2)	7788 (73.9)	10835 (74.2)	< 0.001	0.747
HCV	66 (2.3)	159 (3.1)	484 (4.6)	474 (3.2)	0.951	0.912
HBV + HCV	12 (0.4)	35 (0.7)	113 (1.1)	109 (0.7)	0.685	0.932
Alcohol	155 (5.4)	304 (5.9)	753 (7.1)	1155 (7.9)	< 0.001	0.869
Autoimmune hepatitis	12 (0.4)	41 (0.8)	87 (0.8)	170 (1.2)	< 0.001	0.875
Cholestatic	29 (1.0)	92 (1.8)	154 (1.5)	266 (1.8)	0.005	0.925
Genetic or Metabolic	21 (0.7)	62 (1.2)	105 (1.0)	191 (1.3)	0.019	0.923
Mixed etiology	102 (3.6)	374 (7.3)	864 (8.2)	1188 (8.1)	< 0.001	0.771
Cryptogenic	74 (2.6)	153 (3.0)	70 (0.7)	36 (0.2)	< 0.001	0.746

¹Determined using ordered logistic regression model by comparing proportions of the separated four 5-yr groups.

²Determined using Cochran-Armitage test by comparing proportions of separated years from 2001 to 2020. HBV: Hepatitis B virus; HCV: Hepatitis C virus.

Table 3 Risk factors of in-hospital mortality from 2011 to 2020

Characteristics, n = 25150	Unadjusted		Adjusted1
	OR	P value	OR (95%CI)	P value
Age2	1.49	0.011	1.90 (1.28-2.80)	0.001
Gender	1.25	0.230	0.93 (0.58-1.49)	0.761
Etiology
Viral hepatitis	1.10	0.583	--	--
Alcohol	0.89	0.721	--	--
Other etiologies	Reference	--	--	--
Referring site
Emergency	6.11 (4.67-7.99)	< 0.001	2.97 (2.01-4.38)	< 0.001
Clinic	Reference	--	Reference	--
Insurance status3	1.09 (0.84-1.41)	0.558
MELD4	6.85 (5.15-9.09)	< 0.001	3.55 (2.24-5.64)	< 0.001
Liver transplantation	1.22 (0.57-2.63)	0.764	--	--
Residence
Rural area	3.40 (0.84-13.73)	0.070	3.33 (0.81-13.73)	0.096
Urban area	Reference	--	Reference	--
Complications
Ascites	2.70 (2.06-3.53)	< 0.001	1.74 (1.18-2.56)	0.005
UGIB	2.13 (1.62-2.81)	< 0.001	2.35 (1.59-3.46)	< 0.001
HE	10.63 (8.22-13.74)	< 0.001	3.27 (2.20-4.84)	< 0.001
HCC	1.42 (1.15-1.81)	0.005	6.03 (4.07-8.94)	< 0.001
SBP	4.06 (3.15-5.23)	< 0.001	1.34 (0.92-1.96)	0.123
ACLF	8.60 (6.73-11.00)	< 0.001	4.22 (2.70-6.59)	< 0.001

¹Adjusted by all variables with P value < 0.10 and age, gender in univariate logistic analysis. Multivariate logistic analysis is performed.

²≥ 65 years vs < 65 yr.

³Medical insurance vs self-paying.

⁴Model for end-stage liver disease (MELD) score ≥ 15 points vs MELD score < 15 points. OR: Odds ratio; MELD: Model for end-stage liver disease; UGIB: Upper gastrointestinal bleeding; HE: Hepatic encephalopathy; HCC: Hepatocellular carcinoma; SBP: Spontaneous bacterial peritonitis; ACLF: Acute-on-chronic liver failure.