Long-term mortality in patients admitted acutely for chronic liver disease in England: A national cohort study

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BACKGROUND: Chronic liver disease (CLD) is a growing global health concern. Many CLD patients experience an emergency hospital admission, after which prognosis is often poor. We studied long-term mortality and its key determinants in first emergency admissions (FEA) for CLD in England. METHODS: CLD patients with a FEA between April 2012 and March 2019 were identified in national administrative hospital data, with minimum 5 years follow-up. Proportional hazards modelling was used to estimate adjusted hazard ratios (adjHR) for all-cause mortality according to patient characteristics, aetiology, disease severity, and region of residence. FINDINGS: Of 82,402 CLD patients, 49,398 (59·9%) died within 5 years of FEA. Median survival was 2·72 (95%CI 2·66-2·79) years. Five-year mortality was higher in older patients, men, and those with comorbid conditions. Compared to patients with alcohol-related liver disease, mortality was lower in those with metabolic (adjHR 0·76; 0·73-0·78), combined metabolic and alcohol-related (adjHR 0·80; 0·78-0·82) and autoimmune disease (adjHR 0·82; 0·80-0·85). Manifestations of disease severity, including encephalopathy (adjHR 1·70; 1·62-1·77), ascites (adjHR 1·64; 1·61-1·67), and gastrointestinal bleeding (adjHR 1·10; 1·08-1·12), were associated with increased mortality. Mortality was higher in all eight regions outside London (adjHRs varying from 1·06 (1·02-1·11) to 1·19 (1·13-1·24)). INTERPRETATION: Mortality of CLD patients after a FEA in England is exceptionally high, with marked differences according to sociodemographic characteristics, aetiology, disease severity, and geographic region. Treatment innovations are urgently needed, targeting those at highest risk. Healthcare resource allocation should be reviewed to address potential geographic inequities in outcome.

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