Survival after Hospital Admission in Adults with Liver Cirrhosis in California

Cirrhosis of the liver currently ranks 9th amongst all causes of death in the United States, with a prevalence of 0.27%. In the world, with a prevalence of about 1.4%, it caused around 1.32 million or 2.4% of the total deaths in 2017. Cirrhosis is characterized by widespread fibrosis and regeneration of liver tissue, which is in response to irreversible and usually prolonged damage to the liver. The continued presence of the inciting factor causes progression to end-stage liver disease with or without hepatocellular carcinoma or liver cancer. The commonest cause in the US is chronic viral hepatitis by Hepatitis C or Hepatitis B virus, while alcohol-associated liver disease is more common worldwide. Currently, cirrhosis due to hepatitis is on a downward trend because of newer, more effective therapeutic options, whereas a lifestyle disorder called non-alcoholic fatty liver disease, as a cause of cirrhosis, is on the rise.
Survival with compensated liver cirrhosis is estimated to be around 12 years, while it is only 2 years with the decompensated form of the disease. There has not been any major population-based study in the United States providing us with recent survival estimates. Hence, to obtain current estimates, we used the Health Care Access and Information (HCAI) Patient Discharge Database of the Government of California to obtain a cohort of all California adults with diagnosed liver cirrhosis from 2005 to 2013. This database is linked to the California Comprehensive Master Death File via a unique Record Linkage Number, which allowed us to perform a time-to-death analysis. Using Kaplan-Meier methods, we estimated the median survival time for the sample overall, and stratified by variables like age, sex, race, ethnicity, payment type, and decompensation status. We used Cox proportional hazards regression to estimate hazard ratios for the outcome of death.
Our sample size consisted of 193,127 adults with an average age of 59.4 and a standard deviation of 13.1 years. 63.5% of our sample was male, 70.2% were white, and 30.7% were of Hispanic ethnicity. 39.3% were decompensated at baseline, and 39.1% of the sample used Medicare to pay for the services received. The median survival time for the overall sample was 4.16 (95% CI 4.09-4.24) years, with age more than 68 years and decompensated disease increasing the risk of death by 99% (95% CI 95%-104%) and 53% (95% CI 51%-55%), respectively. Belonging to the Asian race decreased the risk by 7% (95% CI 5%-10%), and the female sex had a 14% (95% CI 13%-16%) lower risk. The median survival for compensated liver disease was 5.37 (95% CI 5.25-5.48) years while it was 2.77 (95% CI 2.71-2.83) years for those decompensated at baseline.