Hepatic cirrhosis according to the forensic medical autopsy data from Moscow for the period of 2007-2016

Abstract

Study purpose is to demonstrate the dynamics of mortality due to hepatic cirrhosis according to forensic medical autopsy data over the period from 2007 to 2016. Material and methods ― 268,139 protocols of forensic autopsies were studied to identify the number of deaths by hepatic cirrhosis over ten years between 2012 and 2016 and to determine the number of cases of liver failure associated with cirrhosis. To clarify the dynamics of mortality due to hepatic cirrhosis, a comparative analysis of two chronologically consecutive five-year periods, 2007-2011 and 2012-2016, has been conducted. The age of deceased by hepatic cirrhosis was studied. The number of cases with a histologically verified form of hepatic cirrhosis was specified. The average values and the percentage ratio of the number of examinations performed to the total number of all autopsies for non-violent death cases were calculated. Results ― Over ten years of study, death by hepatic cirrhosis was diagnosed 3,092 times, including 749 times with histologically confirmed liver failure. In 2009, there was an abrupt increase in mortality due to hepatic cirrhosis by the factor of 3.8, and the lowest mortality level was found in 2016. When comparing the mentioned two quinquennia, the first of them, 2007-2011, was characterized by an increase in the number of diagnosed hepatic cirrhosis. During the second one, 2012-2016, on the contrary, the dynamics of a decrease in the number of hepatic cirrhosis was revealed. At the average, the annual decrease in the number of hepatic cirrhosis diagnosed during the forensic medical examinations of corpses was 7.7%. The number of established cases of liver failure during the first five-year period compared with the data on the second one was significantly greater. In 2010, there were 109 such cases, in 2016 only 13. Among the histologically verified diagnoses, micronodular and mixed forms of hepatic cirrhosis prevailed. Most of the cases of hepatic cirrhosis were found in men aged within 31-40. Conclusion ― It has been found that over the past five years there has been a shift in the forensic-medical mortality values due to hepatic cirrhosis from the increasing trend to the decreasing one. If within the period of 2007-2011 an increase in diagnosed hepatic cirrhosis was observed, then during 2012-2016 a pronounced decreasing tendency in the number of such diagnoses was disclosed. During that time the number of histologically verified cases of hepatic failure decreased by 43.0%. As a cause of death, hepatic cirrhosis was more often recorded in men aged within 30–40.

Histopathological Changes in Liver in Autopsies

“…Acute hepatitis also includes ballooning degeneration of hepatocytes, lobular and sinusoidal inflammation, Kupffer cell hyperplasia, increased apoptotic bodies, and cholestasis. If this process lasts longer than six months, it is deemed chronic and often presents progressive fibrosis [6].…”