TY  - JOUR
A1  - Gu, Wenyi
A1  - Hortlik, Hannah
A1  - Erasmus, Hans-Peter
A1  - Schaaf, Louisa
A1  - Zeleke, Yasmin
A1  - Uschner, Frank Erhard
A1  - Ferstl, Philip
A1  - Schulz, Martin
A1  - Peiffer, Kai-Henrik
A1  - Queck, Alexander David Roger
A1  - Sauerbruch, Tilman
A1  - Brol, Maximilian
A1  - Rohde, Gernot Gerhard Ulrich
A1  - Sanchez, Cristina
A1  - Moreau, Richard
A1  - Arroyo, Vicente
A1  - Zeuzem, Stefan
A1  - Welsch, Christoph
A1  - Trebicka, Jonel
T1  - Trends and the course of liver cirrhosis and its complications in Germany: Nationwide population-based study (2005 to 2018)
T2  - The Lancet Regional Health - Europe
N2  - Background: Cirrhosis is known to have a high prevalence and mortality worldwide. However, in Europe, the epidemiology of cirrhosis is possibly undergoing demographic changes, and etiologies may have changed due to improvements in standard of care. The aim of this population-based study was to analyze the trends and the course of liver cirrhosis and its complications in recent years in Germany.
Methods: We analyzed the data of all hospital admissions in Germany within diagnosis-related groups from 2005 to 2018. The diagnostic records of cirrhosis and other categories of diseases were based on ICD-10-GM codes. The primary outcome measurement was in-hospital mortality. Trends were analyzed through Poisson regression of annual number of admissions. The impact of cirrhosis on overall in-hospital mortality were assessed through the multivariate multilevel logistic regression model adjusted for age, sex, and comorbidities.
Findings: Of the 248,085,936 admissions recorded between 2005 and 2018, a total of 2,302,171(0•94%) were admitted with the diagnosis of cirrhosis, mainly as a comorbidity. Compared with other chronic diseases, patients admitted with cirrhosis were younger, mainly male and had the highest in-hospital mortality rate. Diagnosis of cirrhosis was an independent risk factor of in-hospital mortality with the highest odds ratio (OR:6•2[95%CI:6.1-6•3]) among all diagnoses. The prevalence of non-alcoholic fatty liver disease has increased four times from 2005 to 2018, while alcoholic cirrhosis is 20 times than other etiologies. Bleeding was found to be decreasing over time, but ascites remained the most common complication and was increasing.
Interpretation: This nationwide study demonstrates that cirrhosis represents a considerable healthcare burden, as shown by the increasing in-hospital mortality, also in combination with other chronic diseases. Alcohol-related cirrhosis and complications are on the rise. More resources and better management strategies are warranted.
KW  - cirrhosis
KW  - hospital admission
KW  - male
KW  - mortality
Y1  - 2021
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/78331
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-783310
SN  - 2666-7762
VL  - 12.2022
IS  - 100240
PB  - Elsevier
CY  - Amsterdam
ER  -