Cirrhosis disproportionately affects the US Veteran Affairs (VA) population. Alcoholic liver disease (ALD) pts often delay seeking medical care which may affect their survival. Aim: to evaluate the effect of ALD on early (within 1 yr of cohort entry) decompensation & death in cirrhotic Veterans compared to the rest(non-ALD).
Methods: We identified new cirrhotic Veterans per year(ICD-9 codes 571.2, 571.5, 571.6 coded at least twice; ALD is code 571.2) from 2000-2007 using the AUSTIN central VA database. Decompensation was defined as HE(572.2),HRS(572.4),SBP(567.23),ascites (789.5)or variceal bleeding(456.0,456.2).Charlson comorbidity score(CCM) & diabetes (DM) were covariates. We estimated the risk of early decompensation/death & change in this risk over 2000-2007 with crude models. Logistic regression models were created with death &decompensation as outcomes (covariates: age,sex,ALD,CCM,DM & year).
Results: 81168 Veterans; mean age 59 yrs with 40% ALD(table).ALD pts were younger(57 vs 59 yrs,p<0.0001),had higher CCM(2.2 vs.1.7,p<0.0001) & lower DM(11.7 vs. 14.7%,p,0.0001)than non-ALD.The rate of early decompensation(36.7% vs. 23.8%, p<0.00001)&death (13% vs. 7.7%, p<0.00001)was significantly higher in ALD. There was a significant increase in rate of decompensation in ALD &decrease in non-ALD pts over the study window. The rate of death in ALD remained stable while it decreased in the rest. Logistic regression showed that ALD(OR 1.7 CI1.66-1.77),age(1.5 CI1.34-1.69), CCM (1.32 CI1.31-1.33), increasing years (1.04 CI1.03-1.05) increased while DM(0.69; CI 0.66-0.73) &age (0.994;0.992-0.995) decreased risk of early decompensation. Predictors for early mortality were ALD (1.71 CI1.63-1.79),CCM (1.36 CI1.35-1.38),male sex (1.46 CI1.19-1.79),age (1.019 CI1.017-1.022) while DM(0.59 CI0.55-0.64)& years (0.96 CI0.95-0.97) were protective.
Conclusions: Alcoholic cirrhosis is associated with a significantly higher risk of early decompensation & death compared to the rest in the VA system. This risk persists despite controlling for age, sex and comorbid conditions. The risk of death has remained stably high in ALD but decreased in non-ALD pts while the rate of early decompensation has continued to rise in ALD. Early diagnosis and intervention in veterans with ALD may reduce this risk.