Contribution of alcohol use disorders on the burden of chronic hepatitis C in France, 2008-2013: A nationwide retrospective cohort study

JOURNAL OF HEPATOLOGY

卷:67

Article

Schwarzinger, Michael^1,2  Baillot, Sylvain¹  Yazdanpanah, Yazdan^2,3  Rehm, Juergen^4,5,6,7,8  Mallet, Vincent^9,10,11 

[1] THEN, 39 Quai Valmy, F-75010 Paris, France

[2] Univ Paris Diderot, Sorbonne Paris Cite, INSERM, IAME,UMR 1137, Paris, France

[3] Hop Bichat Claude Bernard, AP HP, Serv Malad Infect & Tropicales, Paris, France

[4] Ctr Addict & Mental Hlth, Social & Epidemiol Res Dept, Toronto, ON, Canada

[5] Univ Toronto, Dalla Lana Sch Publ Hlth, Addict Policy, Toronto, ON, Canada

[6] Univ Toronto, Fac Med, Inst Med Sci, Med Sci Bldg, Toronto, ON, Canada

[7] Univ Toronto, Dept Psychiat, Toronto, ON, Canada

[8] Tech Univ Dresden, Inst Clin Psychol & Psychotherapy, Dresden, Germany

[9] Univ Paris 05, Sorbonne Paris Cite, Paris, France

[10] INSERM, Unite 1223, Inst Pasteur, Paris, France

[11] Grp Hosp Cochin Port Royal, AP HP, Hepatol Serv, Paris, France

关键词: Alcohol use disorders;    Chronic hepatitis C;    Cirrhosis;    Hepatocellular carcinoma;    End-stage liver disease;    Mortality;    Natural history;    Disease progression;    Prognosis;    Burden of disease;   

DOI  :  10.1016/j.jhep.2017.03.031

来源: Elsevier

【 摘 要 】

Background & Aims: Hepatitis C virus (HCV) patients are at risk of alcohol use disorders (AUDs). We measured the contribution of AUDs on the burden of chronic HCV infection in French HCV patients. Methods: The hospital trajectory of 97,347 French HCV patients aged 18-65 in January 2008 were tracked and followed until in-hospital death or December 2013. Primary outcome was the frequency of liver-related complications. Secondary outcomes were the frequency of liver transplantation and otherwise cause-specific mortality. Adjusted odds ratios (OR), population attributable risks of AUDs and other cofactors of liver disease progression associated with HCV transmission were measured. Results: The 28,101 (28.9%) individuals with AUDs had the highest odds for liver-related complications (OR = 7.19; 95% confidence interval [CI], 6.90 to 7.50), liver transplantation (OR = 4.28; 95% CI, 3.80 to 4.82), and liver death (OR = 6.20; 95% CI, 5.85 to 6.58). Alcohol rehabilitation and abstinence were associated with 60% (95% CI, 57% to 63%) and 78% (95% CI, 76% to 80%) reduction of liver-related complications, respectively. The attributable risk of AUDs was 71.8% (95% CI, 66.0 to 76.8) of 17,669 liver-related complications, 67.4% (95% CI, 61.6 to 72.4) of 1,599 liver transplantations, and 68.8% (95% CI, 63.4 to 73.5) of 6,677 liver deaths. The number of liver transplantations remained stable and the number of liver deaths increased, at a faster rate for individuals with AUDs, over the observational period. Conclusion: In France, AUDs contributed to more than two-thirds of the burden of chronic HCV infection in young and middle-aged adults over 2008-2013. Lay summary: This study tracked liver-related complications and mortality of all 97,347 young and middle-aged patients (1865 years old) discharged with chronic HCV infection from French hospitals over 2008-2013. About 30% patients were recorded with alcohol use disorders (AUDs) and had the highest odds for liver-related complications (i.e. decompensated cirrhosis and liver cancer). AUDs contributed to more than two-thirds of 1,599 liver transplantations and 6,677 liver deaths recorded in patients with chronic HCV infection over 2008-2013 in France. Alcohol rehabilitation and abstinence were associated with above a 50% risk reduction of liver-related complications. Promoting alcohol abstinence should receive high priority to reduce the burden of chronic HCV infection. (C) 2017 European Association for the Study of the Liver. Published by Elsevier B.V.

【 授权许可】

Free