Introduction Morbidity and mortality from alcohol related liver disease (ALD) has increased significantly in England. We aimed to assess the impact of the change in the alcohol licensing law in 2005 on hospital admission as well as morbidity and mortality from ALD.
Methods This was a retrospective study between Jan 2006 to Dec 2011. Patients were identified using the ALD code (K70). Our institute is a teaching hospital in South-East England with a referral base of ~300,000 patients. Biochemical, radiological and microbiology data were collected for each patient from computerised records. The reason for hospital presentation, including the length-of-stay (and ITU stay) were collected. The data was analysed using the t test.
Results During the study period there were a total of 294 admissions due to ALD. Amongst these, 33% presented to hospital with one admission and 67% had more than 1 admission. 69% were men (201/294), 31%(93/294) were women. The median age of the women and men in 2006 and 2007 was 56 and 52 years respectively. However, between 2008–2011, the median age of women presenting was 49 years. There was a rise in the number of admissions related to ALD each year: 40%(116/294) in 2006, 45%(133/294) in 2007, 59%(172/294) in 2008, 59%(171/294) in 2009, 66%(193/294) in 2010 and 68%(201/294) in 2011. Presentation with hyperbilirubinaemia was the most common cause of hospital admission at 72%(211/294), followed by gastrointestinal bleeding at 60%(179/294). Spontaneous bacterial peritonitis contributed to 22%(66/294) of admissions. 17%(51/294) had gram-negative and 6%(17/294) presented with gram-positive sepsis, whereas 15%(46/294) had infection of unknown origin. 28%(82/294) warranted ITU admission for organ support. The overall in-hospital mortality was 33%(96/294). The MELD in patients who died was 25 ± 0.9 vs 16.94 ± 0.2 in those that survived (p < 0.0001) each year. The percentage of failing organs each year is shown in the table below.
Conclusion A rise in the number of admissions and re-admissions with ALD in particular with acute on chronic liver failure is a major burden on health services. It is associated with high mortality and with multi-organ failure. Increasing awareness of alcohol as a health hazard needs to be a public health priority. Early recognition of acute on chronic liver failure and timely intervention to prevent its progression is required.
Disclosure of Interest None Declared.
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