J Korean Med Sci.  2020 Jul;35(29):e233. 10.3346/jkms.2020.35.e233.

Changes in Characteristics of Patients with Liver Cirrhosis Visiting a Tertiary Hospital over 15 Years: a Retrospective Multi-Center Study in Korea

• Jang WY
• Chung WJ
• Jang BK
• Hwang JS
• Lee HJ
• Hwang MJ
• Kweon YO
• Tak WY
• Park SY
• Lee SH
• Lee CH
• Kim BS
• Kim SH
• Suh JI
• Park JG

• KMID: 2504698
• DOI: http://doi.org/10.3346/jkms.2020.35.e233

Abstract

Background
Liver cirrhosis has become a heavy burden not only for patients, but also for our society. However, little is known about the recent changes in clinical outcomes and characteristics of patients with cirrhosis-related complications in Korea. Therefore, we aimed to evaluate changes in characteristics of patients with liver cirrhosis in Daegu-Gyeongbuk province in Korea over the past 15 years.
Methods
We retrospectively reviewed the medical records of 15,716 liver cirrhotic patients from 5 university hospitals in Daegu-Gyeongbuk province from 2000 to 2014. The Korean Standard Classification of Diseases-6 code associated with cirrhosis was investigated through medical records and classified according to the year of first visit.
Results
A total of 15,716 patients was diagnosed with cirrhosis. A number of patients newly diagnosed with cirrhosis has decreased each year. In 2000, patients were most likely to be diagnosed with hepatitis B virus (HBV) cirrhosis, followed by alcoholic cirrhosis. There was a significant decrease in HBV (P < 0.001), but alcohol, hepatitis C virus (HCV), and non-alcoholic fatty liver disease (NAFLD) showed a significant increase during the study period (alcohol, P = 0.036; HCV, P = 0.001; NAFLD, P = 0.001). At the time of initial diagnosis, the ratio of Child-Turcotte-Pugh (CTP) class A gradually increased from 23.1% to 32.9% (P < 0.001). The most common cause of liver-related hospitalization in 2000 was hepatocellular carcinoma (HCC) (25.5%); in 2014, gastrointestinal bleeding with esophageal and gastric varices (21.4%) was the most common cause. Cases of hospitalization with liver-related complication represented 76.4% of all cases in 2000 but 70.9% in 2014. Incidence rate of HCC has recently increased. In addition, HCC-free survival was significantly lower in CTP class A than in classes B and C. Finally, there was significant difference in HCC occurrence according to causes (P < 0.001). HBV and HCV cirrhosis had lower HCC-free survival than alcoholic and NAFLD cirrhosis.
Conclusion
In recent years, the overall number of cirrhosis patients has decreased. This study confirmed the recent trend in decrease of cirrhosis, especially of cirrhosis due to HBV, and the increase of HCV, alcoholic and NAFLD cirrhosis. Targeted screening for at-risk patients will facilitate early detection of liver diseases allowing effective intervention and may have decreased the development of cirrhosis and its complications.

Keyword

Liver Cirrhosis; Hepatocellular Carcinoma; Epidemiology

Figure

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  Fig. 1 The decreasing trend of cirrhosis diagnosis by year.

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  Fig. 2 The changing trends of cirrhosis patients by year. (A) Trend of each etiologies. (B) Trend in CTP class of cirrhosis patients at diagnosis.CTP = Child-Turcotte-Pugh, HBV = hepatitis B virus, HCV = hepatitis C virus, NAFLD = non-alcoholic fatty liver disease.

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  Fig. 3 Analysis of causes of initial hospitalization by year.GI = gastrointestinal, HE = hepatic encephalopathy, HRS = hepatorenal syndrome, HCC = hepatocellular carcinoma.

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  Fig. 4 Kaplan-Meier curves showing survival free from HCC after cirrhosis diagnosis. (A) Survival free from HCC for all patients according to period. (B) Survival free from HCC for HBV cirrhosis patients. (C) Survival free from HCC for HCV cirrhosis patients. (D) Survival free from HCC for alcoholic cirrhosis patients. (E) Survival free from HCC for NAFLD cirrhosis patients.HCC = hepatocellular carcinoma, HBV = hepatitis B virus, HCV = hepatitis C virus, NAFLD = non-alcoholic fatty liver disease.

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  Fig. 5 Kaplan-Meier curve showing survival free from HCC according to etiology of cirrhosis.HCC = hepatocellular carcinoma, HBV = hepatitis B virus, HCV = hepatitis C virus, NAFLD = non-alcoholic fatty liver disease.

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