Hospital contacts with alcohol problems prior to liver cirrhosis or pancreatitis diagnosis

Askgaard, Gro; Neermark, Søren; Leon, David A.; Kjær, Mette; Tolstrup, Janne S

doi:10.4254/wjh.v9.i36.1332

Cited by 7 publications

(4 citation statements)

References 38 publications

(56 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For instance, 11% of patients with ALD cirrhosis in Denmark are only diagnosed at death. 25 However, we find it unlikely that the observed time trends were influenced by either code validity or undetected ALD, since coding practices and the proportion of undetected ALD have remained stable during the ICD-10 era. 15 In our previous study, we found a somewhat stable ALD incidence, but forecasted a future decrease driven by progressively lower incidence rates in the birth cohorts born after 1960.…”

Section: Calendar Yearmentioning

confidence: 73%

“…Despite the improved prognosis, the mortality associated with ALD is still very high, and the fact that over two-thirds of patients have end-stage liver disease (cirrhosis) at the time of diagnosis tells us that there is further potential to reduce the overall mortality by earlier intervention. We have previously found that 40% of patients who are diagnosed with ALD cirrhosis have at least one prior hospital contact with alcohol problems (alcohol intoxication, harmful alcohol use, or alcohol dependence) within a 10-year period 25 and that the risk of ALD cirrhosis increases with the number of these contacts. 42 So naturally, hospital contacts with alcohol problems are a potential point of early intervention.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Decreasing Incidence of Alcohol-Related Liver Disease in Denmark: A 25-Year Nationwide Study

Kraglund

Deleuran

Askgaard

et al. 2021

CLEP

Self Cite

View full text Add to dashboard Cite

Purpose: Alcohol consumption has decreased in Denmark in recent years. We aimed to illustrate and investigate the developments in the incidence, hospital care, and mortality of alcohol-related liver disease (ALD) in Denmark during the last 25 years. Patients and Methods: Through nationwide healthcare registries, we identified all Danish patients with incident ALD in 1994-2018. We computed standardized incidence rates by sex, age, and geography, age-specific incidence rates by birth cohort, and standardized prevalence. We enumerated inpatient admissions, days of admission, outpatient visits, and emergency room visits. Lastly, we estimated relative risks of mortality, standardized mortality rates, and the proportion of deaths caused by ALD. Results: The standardized incidence rate decreased from its peak at 357 per 1,000,000 in 2009 to 240 per 1,000,000 in 2018, and the decrease was evident for both sexes and all age groups below 70 years. The standardized prevalence was stable around 0.22% from 2011 onwards. There was an almost fivefold geographic variation in standardized incidence by municipalities, and age-specific incidence rates decreased sequentially with each 5-year birth cohort after 1960. The number of inpatient admissions, days of admission, and emergency room visits decreased during the study period, while the number of outpatient visits was stable. For patients diagnosed in 2014-2018 compared to 1994-1998, the relative risk of 1-year mortality was 0.83 (95% confidence interval: 0.78-0.87), and the standardized mortality along with the proportion of deaths caused by ALD decreased during the study period. Conclusion:The incidence of ALD decreased from 357 to 240 per 1,000,000 over the last 10 years in Denmark. During the same period, the prevalence remained stable around 0.22% and mortality decreased. Additionally, the burden of ALD on hospital care decreased significantly between 1994 and 2018. We anticipate a further decrease in the incidence of ALD in the future.

show abstract

Section: Calendar Yearmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Decreasing Incidence of Alcohol-Related Liver Disease in Denmark: A 25-Year Nationwide Study

Kraglund

Deleuran

Askgaard

et al. 2021

CLEP

Self Cite

View full text Add to dashboard Cite

show abstract

“…Early diagnosis and risk stratification are regarded as being key to improving the prognosis of patients with CLD 3,35,36 . Health care professionals should ensure that risk factors are identified and followed up at all contacts.…”

Section: Limitations Of This Studymentioning

confidence: 99%

Late diagnosis of chronic liver disease in a community cohort (UK biobank): determinants and impact on subsequent survival

et al. 2020

View full text Add to dashboard Cite

BACKGROUND: Chronic liver disease (CLD) is frequently diagnosed at a late stage when prognosis is poor. We aimed to determine the patient factors associated with a late CLD diagnosis and its subsequent impact on survival in order to support early diagnosis initiatives. METHODS: We identified participants of UK biobank (UKB) study who developed first-time advanced CLD within 5-years. We identified factors associated with late diagnosis via logistic regression, and used survival analysis to measure the association between late CLD diagnosis and mortality risk.RESULTS: 725 UKB participants developed first-time advanced CLD event within 5-years. 83% of cases were diagnosed late. Late diagnosis was associated with aetiology; the odds of late diagnosis were twelve times higher for an individual with alcohol-related liver disease (ArLD) versus viral hepatitis (aOR:12.01;p<0.001).Cumulative mortality 5-years after incident advanced CLD was 43.4% (95%CI:39.6-47.0). Late diagnosis was associated with a higher risk of post-advanced CLD mortality for patients with NAFLD (aHR:2.18; 95% CI:0.86-5.51; p=0.10), but not for other aetiologies.CONCLUSIONS: Late CLD diagnosis varies according to aetiology, and is highest for patients with ArLD and non-alcoholic fatty liver disease. The association between late diagnosis and postadvanced CLD mortality may also vary by aetiology.

show abstract

“…An estimated 5-10% of patients with alcohol overuse develop severe alcohol-related liver fibrosis, making alcohol the main reason for advanced liver disease [2]. The average severe alcohol-related liver disease (ALD) patient has been in contact with the healthcare system for alcohol-related problems at the time up to diagnosis [3,4]. This provides ample opportunities for earlier disease detection during the up to 15 years of asymptomatic disease progression [3,5].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of routine liver function tests to identify patients with significant and advanced alcohol-related liver fibrosis

Lindvig

Hansen

Madsen

et al. 2021

Scandinavian Journal of Gastroenterology

View full text Add to dashboard Cite

Aims: Alcohol is the leading cause of cirrhosis, but most patients go undetected until decompensation occurs despite frequent contacts with the healthcare system. We aimed to evaluate the diagnostic accuracy of routine liver function tests compared with indirect and direct fibrosis markers and to assess doctors' abilities to diagnose significant and advanced alcohol-related liver fibrosis. Methods: This study was a retrospective evaluation of liver function tests for diagnosing alcoholrelated liver disease compared to indirect fibrosis tests, the ELF test, and transient elastography. We also surveyed nine doctors who were presented with 225 patient cases from a cross-sectional, biopsycontrolled, single-centre study that evaluated diagnostic tools for alcohol-related liver fibrosis. The doctors assessed each case for significant (F2) or advanced (F3) fibrosis. We assessed inter-rater variability with Fleiss' kappa. Results: Routine liver function tests had poor diagnostic accuracy (highest area under the ROC curve for platelet count ¼ 0.752) and poor sensitivities (10%-67%) when using the upper or lower normal limits as cut-offs. Indirect fibrosis indices performed significantly better but were still inferior to the ELF test and transient elastography. The nine doctors disagreed substantially in their predictions, with Fleiss' kappa of 0.24 (95% CI0.22-0.26) and 0.51 (0.44-0.55) for significant and advanced fibrosis. All nine doctors exhibited poor case-finding abilities with sensitivities of 22-93%. Conclusions: When using routine liver function tests, doctors may fail to diagnose more than half of all alcohol-overusing patients with advanced fibrosis, probably because they rely on upper and lower normal limits of routine liver function tests.

show abstract

Hospital contacts with alcohol problems prior to liver cirrhosis or pancreatitis diagnosis

Cited by 7 publications

References 38 publications

Decreasing Incidence of Alcohol-Related Liver Disease in Denmark: A 25-Year Nationwide Study

Decreasing Incidence of Alcohol-Related Liver Disease in Denmark: A 25-Year Nationwide Study

Late diagnosis of chronic liver disease in a community cohort (UK biobank): determinants and impact on subsequent survival

Diagnostic accuracy of routine liver function tests to identify patients with significant and advanced alcohol-related liver fibrosis

Contact Info

Product

Resources

About