Impact of chronic diseases on the natural history of a Population-Based Cohort with Chronic Liver Disease: all cirrhotics are not equal
AASLD LiverLearning®. Asrani S. Nov 14, 2016; 144639
Label: Health Care Delivery/Access/Quality
Dr. Sumeet Asrani
Dr. Sumeet Asrani
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TITLE: Impact of chronic diseases on the natural history of a Population-Based Cohort with Chronic Liver Disease: all cirrhotics are not equal


Introduction: Identifying subgroups of CLD patients with high morbidity and mortality has relevant implications for population health management. In this population based study, our aim was to study the impact of coexisting chronic conditions on the clinical course of CLD in a diverse U.S. population.
Methods: Population based studies are possible in Dallas-Fort Worth (DFW) using data from DFW council collaborative, capturing data from all hospital admissions (95% of all hospitals, 17 counties, catchment area 7 million). We assembled an inception cohort of all unique patients with CLD with and without diabetes mellitus (DM) and chronic kidney disease (CKD) admitted to any of the 84 facilities in DFW between 2004 and 2006 and followed patients through 9/2015. Death data were incorporated using linkage to death master index.
Results: There were 8777 patients with CLD; of these 2132 patients had DM. CLD patients with DM were older (59 vs. 55 yrs), male (55% vs. 45%), Caucasian (65% vs. 35%), and non-Hispanic (80% vs. 20%). Between 2004 and 2015, there were 3344 re-admissions (1.57 admissions per patient) in DM group and 5598 (0.84 admissions per patient) in the non DM group. Mortality within 10 years was 60.2% vs. 53.5% in the DM vs. no-DM groups; over 85% of deaths in both groups were within 5 years of initial admission.
A subset of patients also had concomitant CKD and DM (n=162). The median survival (95% CI) decreased from 76 (67-88) months in CLD patients to 59 (50-67) months CLD+DM to 17 (11-27) months in CLD+DM+CKD.(Figure) The majority (61.2%) of deaths among CLD patients with DM and CKD occurred among patients aged 45-64 years vs. 51.1% (CLD+DM) and 49.3% (CLD).
Conclusions: In this population based study, CLD patients with co-morbid DM were admitted twice as frequently as those without DM. Overall, CLD patients had poor survival within 10 years of first hospitalization: survival rates were markedly lower in the presence of DM and CKD. Risk stratification by presence of multiple chronic conditions is relevant to target subsets with highest healthcare utilization and untoward mortality.

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