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  The Liver Meeting
San Francisco
November 2018
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Systematic Review: Prevalence and Natural History of Alcohol Related Liver Disease
  "these data confirm the observation that alcohol related hepatic steatosis is not a benign condition and is associated with significant annual mortality."
Reported by Jules Levin
AASLD 2018 Nov 9-13 SF
Richard Parker1,2, S Masson3, I Rowe1,2
1Leeds Liver Unit, St James's University Hospital Leeds UK richardparker@nhs.net @drrichardparker 2. University of Leeds, UK 3. Liver Unit, Freeman Hospital Newcastle UK
Summary - alcohol related liver disease(ArLD) is common but detailed natural history studies are lacking. This systematic review and meta-analysis draws together current evidence regarding the prevalence of histologically-proven ArLD, and the risks of progression to cirrhosis or death from each stage of disease.
Liver disease is common but not universal amongst cohorts of hazardous drinkers. The risk of progression to cirrhosis or death, is greatest in patients with biopsy-proven steatohepatitis. Importantly, patients with hepatic steatosis have a significant risks of death and progressive disease confirming that this is not a benign condition. This meta-analysis is limited by a lack of published data, emphasising the need for high quality prospective studies to describe the hepatic and extra-hepatic consequences of ArLD.
Program abstract
Background: Alcohol related liver disease (ARLD) is a common worldwide. We performed a systematic review to identify studies describing the natural history of ARLD.
Methods:le]) AND prevalence[Title]) OR natural history[Title]) OR epidemiology[Title]) NOT NAFLD, NASH, nonalcoholic, non-alcoholic[Title]. Results were limited to human studies and those in reported in English. Titles were reviewed for relevance. The reference lists of selected manuscripts were reviewed for other relevant studies and citing literature also examined. Data from each study regarding the type of population, definition of ARLD, prevalence, mortality rates and cause of death (liver-related/non-liver related). Average values and confidence intervals were calculated using Prism v5.0.
Results: The literature search yielded 45,034 results, of which 65 appeared relevant on review of manuscript titles. Of these, 32 were included for analysis. Thirteen studies described prevalence data for over 12 million people. In population-based studies, the median prevalence of ARLD was 1840 cases/100,000 (IQR 1133-10,373). In hospital-based studies, the prevalence of ARLD was 92/100,000 (IQR 18.5 - 556). The prevalence of ARLD increased with greater scrutiny of individuals with higher prevalence seen in studies that used ultrasound or biochemical data. Twenty-five studies including 37,810 participants were examined for outcome data. Median follow-up was 8.2 years (IQR 4.1 - 12 years). For ARLD as a single entity (11 studies including 33,504 participants), annualized mortality was 6.35% (4.4 - 12.7), where non-liver related annualized mortality was 4.2% (1.7 - 6.4) and annualized liver-related mortality was 3.1% (2.3 - 10.8).
Annualized non-liver mortality differed by stage of disease: 3.3% (2.55 - 5.35) in patients with hepatic steatosis (5 studies, including 670 patients), 3.8% (0.5 - 5) in alcoholic hepatitis (AH) (3 studies including 2371 patients) and 2.6% (1.6 - 6.4) in patients with ARLD cirrhosis (6 studies including 1265 participants). Annualized liver-related mortality was 1.0% (0.6- 1.2) in hepatic steatosis, 10.4% (5.2 - 16.5) in alcoholic hepatitis and 4.8% (3.7 - 8.9) in ARLD cirrhosis.
Conclusion: This systematic review of studies reporting prevalence and outcomes in ARLD highlights several issues. First, the wide variation in estimates of prevalence and outcome highlight the need for good quality epidemiological and natural history studies. Second, the relatively small number of patient data available for analysis emphasizes findings from other studies that ARLD is under-resourced. Finally, these data confirm the observation that alcohol related hepatic steatosis is not a benign condition and is associated with significant annual mortality.