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Extra-hepatic morbidity and mortality in alcohol-related liver disease: Systematic review and meta-analysis

Lookup NU author(s): Dr Steven MassonORCiD


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© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. Background: Alcohol use increases the risk of many conditions in addition to liver disease; patients with alcohol-related liver disease (ALD) are therefore at risk from both extra-hepatic and hepatic disease. Aims: This review synthesises information about non-liver-related mortality in persons with ALD. Methods: A systematic literature review was performed to identify studies describing non-liver outcomes in ALD. Information about overall non-liver mortality was extracted from included studies and sub-categorised into major causes: cardiovascular disease (CVD), non-liver cancer and infection. Single-proportion meta-analysis was done to calculate incidence rates (events/1000 patient-years) and relative risks (RR) compared with control populations. Results: Thirty-seven studies describing 50 302 individuals with 155 820 patient-years of follow-up were included. Diabetes, CVD and obesity were highly prevalent amongst included patients (5.4%, 10.4% and 20.8% respectively). Outcomes varied across the spectrum of ALD: in alcohol-related fatty liver the rate of non-liver mortality was 43.4/1000 patient-years, whereas in alcoholic hepatitis the rate of non-liver mortality was 22.5/1000 patient-years. The risk of all studied outcomes was higher in ALD compared with control populations: The RR of death from CVD was 2.4 (1.6–3.8), from non-hepatic cancer 2.2 (1.6–2.9) and from infection 8.2 (4.7–14.3). Conclusion: Persons with ALD are at high risk of death from non-liver causes such as cardiovascular disease and non-hepatic cancer.

Publication metadata

Author(s): Theodoreson MD, Aithal GP, Allison M, Brahmania M, Forrest E, Hagstrom H, Johansen S, Krag A, Likhitsup A, Masson S, McCune A, Rajoriya N, Thiele M, Rowe IA, Parker R

Publication type: Article

Publication status: Published

Journal: Liver International

Year: 2023

Volume: 43

Issue: 4

Pages: 763-772

Print publication date: 01/04/2023

Online publication date: 24/01/2023

Acceptance date: 18/01/2023

ISSN (print): 1478-3223

ISSN (electronic): 1478-3231

Publisher: John Wiley and Sons Inc.


DOI: 10.1111/liv.15526

PubMed id: 36694995


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