Hospital of the University of Pennsylvania Philadelphia, PA, United States
Renata Lerer, MD, Kristen Tessiatore, MD, Marina Serper, MD, David Kaplan, MD Hospital of the University of Pennsylvania, Philadelphia, PA
Introduction: Direct-acting antiviral (DAA) therapy for hepatitis C reduces the risk of decompensation and hepatocellular carcinoma among patients with cirrhosis. Long-term population-based data quantifying the effect of DAAs on cause-specific mortality in cirrhosis remain lacking. The aim of this study was to evaluate temporal trends in overall and cause-specific mortality in a national cohort of patients with cirrhosis.
Methods: We performed a retrospective cohort study of patients with cirrhosis diagnosed between 2008-2017 in the Veterans Health administration. We determined cause of death from the Mortality Death Registry and characterized these as following: all-cause mortality, mortality related to liver disease (including liver neoplasm, end-stage liver disease, infection, and GI hemorrhage), and mortality due to liver neoplasm only. Age-adjusted mortality rates, annual adjusted percent change (AAPC) in mortality rate, and inflection points (Joinpoints) were calculated using the SEER*Stat Joinpoint regression program referencing a standard population from US Census data.
Results: 129,700 male patients with cirrhosis were included, 75% related to hepatitis C infection; 20.3% of the total population died during the follow-up period. All-cause mortality declined between 2008-2017, with a change in AAPC rate detected in 2015 from -2.57% to -6.93% (Figure). Similarly, composite liver mortality declined throughout the study period but accelerated after 2013 from -3.09% to -10.2%. By contrast, liver neoplasm-related mortality increased until 2012 (+0.72%), then declined after 2013 (-8.14%).
Discussion: Sharp declines in liver-related death appear to precede the widespread availability of all-oral DAA therapy by about one year suggesting significant impacts of improved general and HCC-related liver care. Both liver neoplasm-related death and composite liver mortality (including liver cancer) decreased significantly after 2013, likely due to secular changes in liver cancer care and improved management of decompensated liver disease. Overall mortality, however, decreased significantly after 2015, most likely due to increased availability of direct-acting antiviral (DAA) agents for hepatitis C. Data should be confirmed in a non-veteran population.
Figure: Age-Adjusted Total, Liver-Neoplasm, and Liver Composite Mortality Rates, 2008-2017
Disclosures: Renata Lerer indicated no relevant financial relationships. Kristen Tessiatore indicated no relevant financial relationships. Marina Serper indicated no relevant financial relationships. David Kaplan indicated no relevant financial relationships.
Renata Lerer, MD, Kristen Tessiatore, MD, Marina Serper, MD, David Kaplan, MD. P2804 - Age-Adjusted Mortality Rates of Liver-Related Death in a VA Cohort of Patients With Cirrhosis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.