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.

Bodger, Keith ORCID: 0000-0002-1825-3239, Mair, Thomas, Schofield, Peità ORCID: 0000-0002-6398-2537, Silberberg, Benjamin, Hood, Steve and Fleming, Kate M (2023) 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-.

Text
Bodger_et_al_BMJ_Open_Accepted.docx - Author Accepted Manuscript
Download (196kB)

Official URL: http://dx.doi.org/10.1136/bmjopen-2023-076955

Abstract

<h4>Objectives</h4>To examine time trends in patient characteristics, care processes and case fatality of first emergency admission for alcohol-related liver disease (ARLD) in England.<h4>Design</h4>National population-based, retrospective observational cohort study.<h4>Setting</h4>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.<h4>Outcome measures</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.

Item Type:	Article
Uncontrolled Keywords:	Humans, Liver Diseases, Alcohol-Related Disorders, Hospitalization, Hospital Mortality, Retrospective Studies, Electronics, Middle Aged, Female, Male
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Population Health
Depositing User:	Symplectic Admin
Date Deposited:	13 Nov 2023 09:12
Last Modified:	11 Dec 2023 14:54
DOI:	10.1136/bmjopen-2023-076955
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3176740