Trends and the course of liver cirrhosis and its complications in Germany: Nationwide population-based study (2005 to 2018)

Wenyi Gu; Hannah Hortlik; Hans-Peter Erasmus; Louisa Schaaf; Yasmin Zeleke; Frank E Uschner; Philip Ferstl; Martin Schulz; Kai-Henrik Peiffer; Alexander Queck; Tilman Sauerbruch; Maximilian Joseph Brol; Gernot Rohde; Cristina Sanchez; Richard Moreau; Vicente Arroyo; Stefan Zeuzem; Christoph Welsch; Jonel Trebicka

doi:10.1016/j.lanepe.2021.100240

Trends and the course of liver cirrhosis and its complications in Germany: Nationwide population-based study (2005 to 2018)

Lancet Reg Health Eur. 2021 Nov 4:12:100240. doi: 10.1016/j.lanepe.2021.100240. eCollection 2022 Jan.

Authors

Wenyi Gu¹, Hannah Hortlik¹, Hans-Peter Erasmus¹, Louisa Schaaf¹, Yasmin Zeleke¹, Frank E Uschner¹, Philip Ferstl¹, Martin Schulz¹, Kai-Henrik Peiffer¹, Alexander Queck¹, Tilman Sauerbruch², Maximilian Joseph Brol¹, Gernot Rohde³, Cristina Sanchez⁴, Richard Moreau^{4

5}, Vicente Arroyo⁴, Stefan Zeuzem¹, Christoph Welsch¹, Jonel Trebicka^{1

4}

Affiliations

¹ Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany.
² Department of Internal Medicine I, University of Bonn, Bonn, Germany.
³ University Hospital Frankfurt, Department of Respiratory Medicine and Allergology, Goethe University Frankfurt, Frankfurt am Main, Germany.
⁴ European Foundation for Study of Chronic Liver Failure, Barcelona, Spain.
⁵ APHP, Hôpital Beaujon, Service d'Hépatologie, Clichy, France; Inserm, Université de Paris, Centre de Recherche sur L´Inflammation, Paris, France.

Abstract

Background: Cirrhosis is known to have a high prevalence and mortality worldwide. However, in Europe, the epidemiology of cirrhosis is possibly undergoing demographic changes, and etiologies may have changed due to improvements in standard of care. The aim of this population-based study was to analyze the trends and the course of liver cirrhosis and its complications in recent years in Germany.

Methods: We analyzed the data of all hospital admissions in Germany within diagnosis-related groups from 2005 to 2018. The diagnostic records of cirrhosis and other categories of diseases were based on ICD-10-GM codes. The primary outcome measurement was in-hospital mortality. Trends were analyzed through Poisson regression of annual number of admissions. The impact of cirrhosis on overall in-hospital mortality were assessed through the multivariate multilevel logistic regression model adjusted for age, sex, and comorbidities.

Findings: Of the 248,085,936 admissions recorded between 2005 and 2018, a total of 2,302,171(0•94%) were admitted with the diagnosis of cirrhosis, mainly as a comorbidity. Compared with other chronic diseases, patients admitted with cirrhosis were younger, mainly male and had the highest in-hospital mortality rate. Diagnosis of cirrhosis was an independent risk factor of in-hospital mortality with the highest odds ratio (OR:6•2[95%CI:6.1-6•3]) among all diagnoses. The prevalence of non-alcoholic fatty liver disease has increased four times from 2005 to 2018, while alcoholic cirrhosis is 20 times than other etiologies. Bleeding was found to be decreasing over time, but ascites remained the most common complication and was increasing.

Interpretation: This nationwide study demonstrates that cirrhosis represents a considerable healthcare burden, as shown by the increasing in-hospital mortality, also in combination with other chronic diseases. Alcohol-related cirrhosis and complications are on the rise. More resources and better management strategies are warranted.

Funding: The funders had no influence on this study.

Keywords: ALD, alcoholic liver diseases; DAA, direct-acting antiviral; DALYs, disability-adjusted life years; HBV, hepatitis B virus; HCV, hepatitis C virus; ICD, International Classification of Diseases; NAFLD, non-alcoholic fatty liver disease; NASH, non-alcoholic steatohepatitis; OPS, operation and procedure key system; YLDs, years lived with disability; YLLs, years of life lost; cirrhosis; hospital admission; male; mortality.