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Comorbid Chronic Diseases and Survival in Compensated and Decompensated Cirrhosis: A Population-Based Study
Sumeet K Asrani1, Lauren Hall2, Vikrant Reddy2
1Baylor University Medical Center, Dallas, Texas, USA.
Insights
Comorbid chronic diseases significantly increase mortality risk in cirrhosis patients. Managing these conditions, like diabetes and cardiovascular disease, is crucial for improving survival, even in compensated cirrhosis.
Area of Science:
- Hepatology and internal medicine.
- Clinical epidemiology.
Background:
- Liver disease, particularly cirrhosis, presents a substantial and growing health burden.
- The impact of co-occurring chronic diseases on cirrhosis patient outcomes is not fully understood.
Purpose of the Study:
- To investigate the individual and combined effects of chronic diseases on mortality in patients with cirrhosis.
Main Methods:
- A population-based study utilizing Cox proportional hazards modeling.
- Time-dependent covariates were employed to assess mortality risk.
- Comorbidities analyzed included diabetes mellitus, chronic kidney disease, and cardiovascular disease (CVD).
Main Results:
- The study included 35,361 patients with cirrhosis.
- Mortality risk progressively increased with the number of chronic diseases: HR 2.5 for 1 disease, 3.27 for 2 diseases, and 4.52 for 3 diseases.
- Survival in compensated cirrhosis patients with 3 chronic diseases was comparable to decompensated cirrhosis patients with 1-3 conditions.
Conclusions:
- Comorbid chronic diseases are significant predictors of mortality in cirrhosis patients.
- Targeting management of conditions like diabetes, CKD, and CVD may reduce premature deaths.
- Multidisciplinary care is essential early in cirrhosis management, beyond just portal hypertension complications.
Introduction:
The burden of liver disease is substantial and increasing; the impact of comorbid chronic diseases on the clinical course of patients with compensated and decompensated cirrhosis is not well-defined. The aim of this study was to examine the individual and additive impact of comorbid chronic diseases on mortality in patients with cirrhosis.
Methods:
In this population-based study, we used Cox proportional hazards modeling with time-dependent covariates to assess the impact of comorbid chronic diseases (diabetes mellitus, chronic kidney disease, and cardiovascular disease [CVD]) on mortality in patients with cirrhosis in a large, diverse Metroplex.
Results:
There were 35,361 patients with cirrhosis (mean age 59.5 years, 41.8% females, 29.7% non-White, and 17.5% Hispanic ethnicity). Overall, the presence of chronic comorbidities was 1 disease (28.9%), 2 diseases (17.5%), and 3 diseases (12.6%) with a majority having CVD (45%). Adjusted risk of mortality progressively increased with an increase in chronic diseases from 1 (hazard ratio [HR] 2.5, 95% confidence interval [CI] 2.23-2.8) to 2 (HR 3.27.95% CI 2.9-3.69) to 3 (HR 4.52, 95% CI 3.99-5.12) diseases. Survival of patients with compensated cirrhosis and 3 chronic diseases was similar to subsets of decompensated cirrhosis (67.7% as compared with decompensated cirrhosis with 1-3 conditions, 61.9%-63.9%).
Discussion:
In patients with cirrhosis, a focus on comorbid chronic disease(s) as potential management targets may help avoid premature mortality, regardless of etiology. Multidisciplinary care early in the clinical course of cirrhosis is needed in addition to the current focus on management of complications of portal hypertension.
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