Outcomes of first emergency admissions for alcohol-related liver disease in England over a 10-year period: retrospective observational cohort study using linked electronic databases.
BMJ Open
; 13(11): e076955, 2023 11 22.
Article
em En
| MEDLINE
| ID: mdl-37993152
ABSTRACT
OBJECTIVES:
To examine time trends in patient characteristics, care processes and case fatality of first emergency admission for alcohol-related liver disease (ARLD) in England.DESIGN:
National population-based, retrospective observational cohort study.SETTING:
Clinical Practice Research Datalink population of England, 2008/2009 to 2017/2018. First emergency admissions were identified using the Liverpool ARLD algorithm. We applied survival analyses and binary logistic regression to study prognostic trends. OUTCOMEMEASURES:
Patient characteristics; 'recent' General Practitioner (GP) consultations and hospital admissions (preceding year); higher level care; deaths in-hospital (including certified cause) and within 365 days. Covariates were age, sex, deprivation status, coding pattern, ARLD stage, non-liver comorbidity, coding for ascites and varices.RESULTS:
17 575 first admissions (mean age 53 years; 33% women; 32% from most deprived quintile). Almost half had codes suggesting advanced liver disease. In year before admission, only 47% of GP consulters had alcohol-related problems recorded; alcohol-specific diagnostic codes were absent in 24% of recent admission records. Overall, case fatality rate was 15% in-hospital and 34% at 1 year. Case-mix-adjusted odds of in-hospital death reduced by 6% per year (adjusted OR (aOR) 0.94; 95% CI 0.93 to 0.96) and 4% per year at 365 days (aOR 0.96; 95% CI 0.95 to 0.97). Exploratory analyses suggested the possibility of regional inequalities in outcome.CONCLUSIONS:
Despite improving prognosis of first admissions, we found missed opportunities for earlier recognition and intervention in primary and secondary care. In 2017/2018, one in seven were still dying during index admission, rising to one-third within a year. Nationwide efforts are needed to promote earlier detection and intervention, and to minimise avoidable mortality after first emergency presentation. Regional variation requires further investigation.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Transtornos Relacionados ao Uso de Álcool
/
Hepatopatias
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article