Alcohol-related Liver Disease is Rarely Detected at Early Stages Compared With Liver Diseases of Other Etiologies Worldwide
Background & Aims: Despite recent advances in treatment of viral hepatitis, liver-related mortality is high, possibly due to the large burden of advanced alcohol-related liver disease (ALD). We investigated whether patients with ALD are initially seen at later stages of disease development than patients with hepatitis C virus (HCV) infection or other etiologies. Methods: We performed a cross-sectional study of 3453 consecutive patients with either early or advanced liver disease (1699 patients with early and 1754 with advanced liver disease) seen at 17 tertiary care liver or gastrointestinal units worldwide, from August 2015 through March 2017. We collected anthropometric, etiology, and clinical information as well as and model for end-stage liver disease (MELD) scores. We used unconditional logistic regression to estimate the odds ratios for evaluation at late stages of the disease progression. Results: Of the patients analyzed, 81% had 1 etiology of liver disease and 17% had 2 etiologies of liver disease. Of patients seen at early stages for a single etiology, 31% had HCV infection, 21% had HBV infection, and 17% had non-alcoholic fatty liver disease, whereas only 3.8% had ALD. In contrast, 29% of patients seen for advanced disease had ALD. Patients with ALD were more likely to be seen at specialized centers, with advanced-stage disease, compared to patients with HCV-associated liver disease (odds ratio, 14.1; 95% CI, 10.5–18.9; P <.001). Of patients with 2 etiologies of liver disease, excess alcohol use was associated with 50% of cases. These patients had significantly more visits to healthcare providers, with more advanced disease, compared to patients without excess alcohol use. The mean MELD score for patients with advanced ALD (16) was higher than for patients with advanced liver disease not associated with excess alcohol use (13) (P<.01). Conclusion: In a cross-sectional analysis of patients with liver disease worldwide, we found that patients with ALD are seen with more advanced-staged disease than patients with HCV-associated liver disease. Of patients with 2 etiologies of liver disease, excess alcohol use was associated with 50% of cases. Early detection and referral programs are needed for patients with ALD, worldwide.