J Korean Med Sci.  2021 May;36(21):e145. 10.3346/jkms.2021.36.e145.

Changing Trends in Liver Cirrhosis Etiology and Severity in Korea: the Increasing Impact of Alcohol

• Yoon JH
• Jun CH
• Kim JH
• Yoon EL
• Kim BS
• Song JE
• Suk KT
• Kim MY
• Kang SH

• KMID: 2516502
• DOI: http://doi.org/10.3346/jkms.2021.36.e145

Abstract

Background
Chronic hepatitis B is the most common cause of liver cirrhosis in South Korea. However, alcoholic liver disease has shown an increasing trend. Although the clinical implications surrounding liver cirrhosis have been changing over the years, few studies have recently examined cirrhosis epidemiology. Therefore, we aimed to investigate changes in liver cirrhosis etiology and severity in Korea.
Methods
We retrospectively reviewed 16,888 records of cirrhotic patients from six tertiary hospitals in Korea from 2008 to 2017. Continuous and non-continuous variables were processed via linear and Poisson regression, expressed as beta (B) coefficients and as exponentiated values of coefficients (Exp[B]), respectively.
Results
Chronic hepatitis B showed a decreasing trend (Exp[B] = 0.975, P < 0.001), whereas alcohol showed an increasing trend (Exp[B] = 1.013, P = 0.003), occupying the most common etiology in 2017. The Child-Turcotte-Pugh (CTP) score and decompensated liver cirrhosis prevalence did not change over the 10-year period. The incidence of variceal bleeding, severe ascites, hepatic encephalopathy, and spontaneous bacterial peritonitis significantly decreased from 12.3% to 7.7%, 7.8% to 4.1%, 1.0% to 0.5%, and 1.9% to 1.1%, respectively (P < 0.05 for all). In the subgroup analysis, the chronic hepatitis B group showed improving CTP scores (B = −0.025, P < 0.001) and decreasing decompensated liver cirrhosis rates (Exp[B] = 0.977, P = 0.016), whereas the alcohol group demonstrated increasing CTP class C (Exp[B] = 1.031, P = 0.005) and model for end-stage liver disease scores (B = 0.081, P = 0.005) over 10 years.
Conclusion
The chronic hepatitis B group exhibited improved results, whereas the alcohol group still presented poor liver functions and outcomes. Future national policies and systematic approaches addressing the incidence, prevention, and treatment of alcoholic liver cirrhosis are indispensable.

Keyword

Alcohol; Cirrhosis; Epidemiology; Hepatitis B Virus

Figure

• 

  Fig. 1 Trends in the proportion of patients with underlying etiology of liver cirrhosis from 2008 to 2017. There was a significant decrease in hepatitis B virus-related liver cirrhosis cases and an increase in alcohol-related liver cirrhosis cases.HBV = hepatitis B virus, HCV = hepatitis C virus, NAFLD = non-alcoholic fatty liver disease, PBC = primary biliary cholangitis, PSC = primary sclerosing cholangitis.

• 

  Fig. 2 Comparison of changes in the liver function between the alcohol and HBV groups from 2008 to 2017. (A) The CTP score of the HBV and alcohol groups. (B) The MELD score of the HBV and alcohol groups.CTP = Child-Turcotte-Pugh, HBV = hepatitis B virus, MELD = model for end-stage liver disease.

• 

  Fig. 3 The CTP scores in the (A) alcohol and (B) HBV groups. The proportion of patients with CTP C in the alcohol group showed an increasing trend of 3.1%/year (95% CI, 0.9–5.3%; P = 0.005), whereas that of patients with CTP B and C in the HBV group showed a decreasing trend of −3.1%/year (95% CI, −5.0% to −1.1%; P < 0.001).CI = confidence interval, CTP = Child-Turcotte-Pugh, HBV = hepatitis B virus.

• 

  Fig. 4 Decompensated liver cirrhosis rates in the HBV and alcohol groups. The alcohol group exhibited no significant difference in the decompensated liver cirrhosis rate during the 10-year period, whereas the HBV group showed a decreasing trend of −2.3%/year (95% CI, −4.1% to −0.4%; P = 0.016).HBV = hepatitis B virus, CI = confidence interval.

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