Highest mortality rate of any chronic disease – healing practice

Liver cirrhosis has the highest mortality rate of any chronic disease

Liver cirrhosis can develop undetected for a long time because at the beginning of the disease there are often no or only general symptoms. A new study now shows that of all chronic diseases that require hospital admission in Germany, liver cirrhosis has the highest mortality rate.

Liver cirrhosis is a serious liver disease that develops gradually as a result of prolonged exposure to alcohol abuse or chronic liver inflammation (hepatitis). Every year tens of thousands of people in Germany die as a result of the disease.

• Liver cirrhosis has the highest mortality rate of any chronic disease requiring hospitalization in this country.
• When diagnosed as a comorbidity with other chronic diseases, it at least doubles the mortality rate.
• The number of hospitalizations with liver cirrhosis has increased despite the introduction of highly effective drugs for hepatitis C nationwide. Alcohol abuse remains by far the leading cause.

Fourth leading cause of death in Central Europe

As in a current Message of the Frankfurt University Hospital, cirrhosis, in which functional liver tissue is lost and scarred, is the common end stage of most chronic liver diseases and the fourth most common cause of death in Central Europe.

So far, however, there has been little current knowledge about its epidemiological profile in Germany.

Therefore, a research team led by Prof. Jonel Trebicka decoded the approximately 250 million hospital admissions that had taken place in Germany from 2005 to 2018 for any reason from 2005 to 2018, according to the 10th version of the International Statistical Classification of Diseases (ICD-10) using the data sets from the Federal Statistical Office.

According to the information, 0.94 percent of these hospitalizations were associated with the diagnosis of cirrhosis of the liver, in the majority of cases as a concomitant and not as the main disease. In absolute numbers, admissions with cirrhosis of the liver increased from 151,108 to a total of 181,688 during the observation period.

The primary endpoint of the study, recently published in the journal “The Lancet Regional Health – Europe‘ was the in-hospital mortality from cirrhosis of the liver.

Fortunately, this mortality rate fell from 11.57 to 9.49 percent during the observation period, but is still well above the corresponding rates of other chronic diseases such as heart failure (8.4%), kidney failure (6.4%) and chronic obstructive pulmonary disease (5.2%).

When cirrhosis of the liver occurred concomitantly with another chronic disease, it increased its mortality rate two to threefold, most notably in infectious respiratory diseases.

Cirrhosis caused by alcohol abuse dominates

Thanks to the introduction of directly effective antiviral drugs against hepatitis C diseases, the proportion of HCV-related cirrhosis fell to almost a third during the observation period.

Conversely, the incidence of cirrhosis caused by non-alcoholic fatty liver are caused, quadrupled during this time, parallel to an increase in patients with morbid overweight (obesity).

Unaffected by these etiological shifts, cirrhosis caused by alcohol abuse continues to dominate. They make up 52 percent of all cirrhosis cases recorded in the study, and the absolute numbers are increasing.

Bleeding in the gastrointestinal tract as a complication of liver cirrhosis in hospitals is becoming increasingly rare, presumably due to the treatment guidelines that are widely followed in German hospitals, for example through endoscopic procedures or the administration of non-selective beta-blockers.

According to the experts, bleeding from varicose veins in the esophagus had even decreased to a tenth of its initial value in 2005 in 2018. On the other hand, however, worsening of the clinical picture due to abdominal dropsy (ascites) or brain disorders due to insufficient detoxification work of the liver has increased.

And the number of portal vein thromboses in turn doubled in parallel with more intensive imaging diagnostics.

Significantly younger patients

Compared to other chronic diseases, the patients admitted with cirrhosis were significantly younger: half of them had not yet exceeded the age of 64.

Higher rates of hospitalization and hospital mortality were recorded in the east German federal states than in the west German states. Nationwide, around two thirds of the patients hospitalized with liver cirrhosis were men.

They often died in their sixth decade of life or earlier, which explains the large number of years of healthy life lost and the high socioeconomic burden associated with liver cirrhosis. Because men of this age still make up the majority of all working people.

“The results of our study show that decision-makers and health care payers should invest much more in the prevention of alcohol-related liver cirrhosis,” explains Prof. Jonel Trebicka.

“They also make it clear how important it is to perceive and treat liver cirrhosis as a concomitant disease of other chronic diseases.” (ad)