Several years after diagnosis, people with alcohol-related liver disease (ALD), irrespective of age or sex, have a high mortality rate, and almost half of those deaths are attributable to liver-related complications, according to study findings published in The Lancet Gastroenterology & Hepatology.

Over time, heavy alcohol use can cause serious liver problems, including fibrosis, cirrhosis and hepatocellular carcinoma, the most common type of liver cancer. Heavy alcohol consumption is a leading cause of liver cancer, liver failure (decompensation) and the need for a liver transplant. A better understanding of the specific causes of mortality among people with ALD is needed to prevent premature death.

Anna Emilie Kann, MD, of the Zealand University Hospital in Denmark, and colleagues analyzed cause-specific mortality, as well as deaths due to certain types of cancer, among people with alcohol-related liver disease.

The researchers accessed Danish nationwide health registries to identify adults who were first diagnosed with ALD between January 2002 and December 2017. They tracked causes of death through December 2019. They also assessed cause-specific mortality broken down by sex, age, diabetes status and severity of alcohol-related liver disease.

The study population consisted of 23,385 people newly diagnosed with ALD. About two thirds were men, the median age was 58 years and 66% had cirrhosis. Over more than 111,500 person-years of follow-up, 67% died, with liver disease being the predominant cause. All-cause mortality rates were 26% at one year and 53% at five years.

The five-year risk of death due to liver disease was 26%, and the 10-year risk was 31%. The 10-year risk was similar for both sexes, across age groups and irrespective of diabetes status. People with decompensated cirrhosis were three times more likely to die from liver disease, with a liver-related mortality rate of 47%.

Within five years of an ALD diagnosis, nearly half of all deaths were attributable to liver complications. After five years, liver disease was responsible for less than half of deaths, as more were attributable to all other causes combined. At 10 years, the most common non-liver-related causes of death were cancer (11%), alcohol use disorder (5.1%) and heart disease (4.5%). Hepatocellular carcinoma was the dominant cause of cancer-related death (2.5%), followed by lung cancer (1.9%) and mouth and throat cancers (1.0%).

“Patients diagnosed with alcohol-related liver disease were at high risk of dying from liver disease many years after diagnosis, irrespective of age and sex,” wrote the study authors. “Death due to specific cancers, including hepatocellular carcinoma, each contributed minimally to the total mortality in patients with alcohol-related liver disease.”

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