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Trends and the course of liver cirrhosis and its complications in Germany: Nationwide population-based study (2005 to 2018)
Copyright policy )Elsevier BVTrends and the course of liver cirrhosis and its complications in Germany: Nationwide population-based study (2005 to 2018)
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.
- Goethe University Frankfurt Germany
- University of Bonn Germany
Microsoft Academic Graph classification: Risk factor Years of potential life lost Comorbidity medicine.disease medicine Odds ratio Mortality rate Population education.field_of_study education Alcoholic liver disease Pediatrics medicine.medical_specialty Cirrhosis business.industry business
Health Policy, Oncology, Internal Medicine, cirrhosis, hospital admission, male, mortality, Public aspects of medicine, RA1-1270, Research Paper, 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
Health Policy, Oncology, Internal Medicine, cirrhosis, hospital admission, male, mortality, Public aspects of medicine, RA1-1270, Research Paper, 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
Microsoft Academic Graph classification: Risk factor Years of potential life lost Comorbidity medicine.disease medicine Odds ratio Mortality rate Population education.field_of_study education Alcoholic liver disease Pediatrics medicine.medical_specialty Cirrhosis business.industry business
citations This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).16 popularity This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.Average influence This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).Average impulse This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.Average citations This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).16 popularity This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.Average influence This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).Average impulse This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.Average
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- Goethe University Frankfurt Germany
- University of Bonn Germany
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.