A Study on the Temporal Trends in the Etiology of Cirrhosis of Liver in Coastal Eastern Odisha
Debakanta Mishra, Kaibalya R Dash, Chittaranjan Khatua, Subhendu Panigrahi, Prasanta K Parida, Sambit K Behera, Rakesh K Barik, Subhasis Pradhan, Saroj K Sahu, Bhaskar Thakur
Alcohol, Cirrhosis of liver, Nonalcoholic steatohepatitis, Viral hepatitis
Citation Information :
Mishra D, Dash KR, Khatua C, Panigrahi S, Parida PK, Behera SK, Barik RK, Pradhan S, Sahu SK, Thakur B. A Study on the Temporal Trends in the Etiology of Cirrhosis of Liver in Coastal Eastern Odisha. Euroasian J Hepatogastroenterol 2020; 10 (1):1-6.
Background: The etiology of cirrhosis of liver is known to change with time due to various factors including awareness, preventive interventions, and lifestyle changes in society. However, there is scarce Indian data available about temporal trends in etiology of cirrhosis of liver. Hence, the aim of this study was to study the temporal trends in the etiology of cirrhosis of liver. Materials and methods: This is a retrospective study conducted in the Department of Gastroenterology, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, from January 2005 to December 2017. Data were collected from hospital records of all patients admitted to the Gastroenterology unit. A Poisson regression model was used to compare the hospitalization rate for different etiologies of cirrhosis of liver. All data were analyzed using Stata version 5.1 software. Results: A total of 4,331 hospitalized patients of cirrhosis of liver were included in the analysis, of whom 2,742 (63.3%) had alcohol-related cirrhosis, 858 (19.8%) had viral hepatitis-related cirrhosis, and 731 (16.9%) had cirrhosis of liver due to nonalcohol and nonviral causes. The proportion of alcohol-related cirrhosis was increased by 26% from 2005 to 2017 (RR 1.26, p for trend <0.001). Though there were minimal ups and downs observed in the admission rate of viral hepatitis-related liver cirrhosis during later years, this was remarkably reduced by 73% (RR 0.27, p for trend <0.001) in the year 2017 at the end of the study. Similarly, the proportion of cirrhosis due to nonalcohol and nonviral causes decreased by 26% (RR 0.74, p for trend <0.001) by 2017. Conclusion: Alcohol is the most common cause of cirrhosis of liver and the burden of alcohol-related cirrhosis is significantly increasing in comparison to other causes including viral infection, nonalcoholic steatohepatitis (NASH), and autoimmune hepatitis.
Mokdad AA, Lopez AD, Shahraz S, et al. Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis. BMC Med 2014;12(1):145. DOI: 10.1186/s12916-014-0145-y.
Anthony PP, Ishak KG, Nayak NC, et al. The morphology of cirrhosis: Definition, nomenclature, and classification. Bull World Health Organ 1977;55(4):521–540.
Hytiroglou P, Snover DC, Alves V, et al. Beyond “cirrhosis“: a proposal from the International Liver Pathology Study Group. Am J Clin Pathol 2012;137(1):5–9. DOI: 10.1309/AJCP2T2OHTAPBTMP.
WHO. Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: World Health Organization; 2016.
Dufour MC. Alcoholic liver disease. GI epidemiology Talley NJ, Locke GR, Saito YA 1st edn., Massachusetts: Blackwell Publishing Inc; 2007. pp. 231–237.
Perz JF, Armstrong GL, Farrington LA, et al. The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J Hepatol 2006;45(4):529–538. DOI: 10.1016/j.jhep.2006.05.013.
Brunt EM. Non-alcohol fatty liver disease. MacSween's Pathology of the Liver Burt 5th edn., Philadelphia, PA: Churchill Livingstone; 2007. pp. 367–397.
World Life Expectancy. India: Liver Disease. In: World Health Rankings. World Life Expectancy. Available at: https://www.worldlifeexpectancy.com/india-liver-disease, Accessed on 9 November 2018.
OECD (2017), “Alcohol consumption among adults”, in Health at a Glance 2017: OECD Indicators, OECD Publishing, Paris 10.1787/health_glance-2017-17-en.
Singh SP, Padhi PK, Narayan J, et al. Socioeconomic impact of alcohol in patients with alcoholic liver disease in eastern India. Indian J Gastroenterol 2016;35(6):419–424. DOI: 10.1007/s12664-016-0699-z.
Younossi ZM, Koenig AB, Abdelatif D, et al. Global epidemiology of nonalcoholic fatty liver disease - meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64(1):73–84. DOI: 10.1002/hep.28431.
Angulo P. GI epidemiology: nonalcoholic fatty liver disease. Aliment Pharmacol Ther 2007;25(8):883–889. DOI: 10.1111/j.1365-2036.2007.03246.x.
Pati GK, Singh SP. Nonalcoholic fatty liver disease in South Asia. Euroasian J Hepato-Gastroenterol 2016;6(2):154–162. DOI: 10.5005/jp-journals-10018-1189.
Bhattacharyya M, Barman NN, Goswami B. Survey of alcohol-related cirrhosis at a tertiary care center in North East India. Indian J Gastroenterol 2016;35(3):167–172. DOI: 10.1007/s12664-016-0651-2.
Sarin SK, Chari S, Sundaram KR, et al. Young v adult cirrhotics: a prospective, comparative analysis of the clinical profile, natural course and survival. Gut 1988;29(1):101–107. DOI: 10.1136/gut.29.1.101.
Ray G, Ghoshal UC, Banerjee PK, et al. Aetiological spectrum of chronic liver disease in eastern India. Trop Gastroenterol 2000;21(2):60–62.
Sharma B, Marwah R, Raina S, et al. A study on the etiology of cirrhosis of liver in adults living in the hills of Himachal Pradesh, India. Trop Gastro 2017;37(1):37–41. DOI: 10.7869/tg.317.
Pati GK, Singh A, Misra B, et al. Acute-on-chronic liver failure (ACLF) in Coastal Eastern India: “A Single-Center Experience”. J Clin Exp Hepatol 2016;6(1):26–32. DOI: 10.1016/j.jceh.2015.08.002.
Ramanathan S, Khandelwal N, Kalra N, et al. Correlation of HVPG level with CTP score, MELD Score, ascites, size of varices, and etiology in cirrhotic patients. Saudi J Gastroenterol 2016;22(2):109–115. DOI: 10.4103/1319-3767.164185.
Kumar R, Kumar P, Saxena KN, et al. Vitamin D status in patients with cirrhosis of the liver and their relatives - A case control study from North India. Indian J Gastroenterol 2017;36(1):50–55. DOI: 10.1007/s12664-017-0727-7.
Bishnu S, Ahammed SM, Sarkar A, et al. Effects of atorvastatin on portal hemodynamics and clinical outcomes in patients with cirrhosis with portal hypertension: a proof-of-concept study. Eur J Gastroenterol Hepatol 2018;30(1):54–59. DOI: 10.1097/MEG.0000000000001006.
Shah AS, Amarapurkar DN. Natural history of cirrhosis of liver after first decompensation: A prospective study in India. J Clin Exp Hepatol 2018;8(1):50–57. DOI: 10.1016/j.jceh.2017.06.001.
Punekar P, Sharma AK, Jain A. A study of thyroid dysfunction in cirrhosis of liver and correlation with severity of liver disease. Indian J Endocrinol Metab 2018;22(5):645–650. DOI: 10.4103/ijem.IJEM_25_18.
Kirnake V, Arora A, Sharma P, et al. Non-invasive aspartate aminotransferase to platelet ratio index correlates well with invasive hepatic venous pressure gradient in cirrhosis. Indian J Gastroenterol 2018;37(4):335–341. DOI: 10.1007/s12664-018-0879-0.
Kulkarni S, Sharma M, Rao PN, et al. Acute on chronic liver failure-in-hospital predictors of mortality in ICU. J Clin Exp Hepatol 2018;8(2):144–155. DOI: 10.1016/j.jceh.2017.11.008.
Patil AG, Bihari C, Shewade HD, et al. Decreased protein C function predicts mortality in patients with cirrhosis. Int J Lab Hematol 2018;40(4):466–472. DOI: 10.1111/ijlh.12836.
Ray G. Trends of chronic liver disease in a tertiary care referral hospital in eastern India. Indian J Public Health 2014;58(3):186–194. DOI: 10.4103/0019-557X.138630.
Mukherjee PS, Vishnubhatla S, Amarapurkar DN, et al. Etiology and mode of presentation of chronic liver diseases in India: a multi centric study. PloS one. 2017(10):12. DOI: 10.1371/journal.pone.0187033.
Thomson SJ, Westlake S, Rahman TM, et al. Chronic liver disease--an increasing problem: a study of hospital admission and mortality rates in England, 1979-2005, with particular reference to alcoholic liver disease. Alcohol Alcohol. 2008;43(4):416–422. DOI: 10.1093/alcalc/agn020.
Bao X-Y, Xu B-B, Fang K, et al. Changing trends of hospitalisation of liver cirrhosis in Beijing, China. BMJ Open Gastro 2015;2(1):e000051. DOI: 10.1136/bmjgast-2015-000051.
Kim D, Li AA, Gadiparthi C, et al. Changing trends in etiology-based annual mortality from chronic liver disease, from 2007 through 2016. Gastroenterology 2018;155(4):1154–1163. DOI: 10.1053/j.gastro.2018.07.008.
Prasad R. Alcohol use on the rise in India. Lancet 2009;373(9657):17–18. DOI: 10.1016/S0140-6736(08)61939-X.
Chiang CJ, Yang YW, You SL, et al. Thirty-year outcomes of the national hepatitis B immunization program in Taiwan. JAMA 2013;310(9):974–976. DOI: 10.1001/jama.2013.276701.
Govt of India. Operational guidelines for the introduction of Hepatitis B vaccine in UIP of India. New Delhi: Mo HFW, Govt of India; 2008.
Singh S, Misra B, Panda C, et al. Study on awareness about Hepatitis B viral infection in coastal Eastern India. Hep B Annual 2009;6(1):19–28. DOI: 10.4103/0972-9747.76902.
Wong MCS, Huang JLW, George J, et al. The changing epidemiology of liver diseases in the Asia-Pacific region. Nat Rev Gastroenterol Hepatol 2019;16(1):57–73. DOI: 10.1038/s41575-018-0055-0.