Cause-specific mortality among Queensland people with cirrhosis, by cirrhosis aetiology and decompensation status, 2007-22: a retrospective cohort study.

objectiveTo determine the cumulative incidence of overall and cause-specific mortality among Queensland residents admitted to hospital with cirrhosis during 2007-22, by cirrhosis aetiology. STUDY

designRetrospective cohort study; analysis of linked Queensland Hospital Admitted Patient Data Collection and Queensland Registry of Births, Deaths and Marriages data. SETTING,

participantsAdult Queensland residents (18 years or older) admitted to Queensland hospitals with cirrhosis during 1 July 2007 - 31 December 2022.

main outcome measuresTen-year mortality, all-cause and cause-specific (liver-related, extrahepatic cancer, cardiovascular disease), by cirrhosis aetiology.

resultsA total of 22 525 people were followed for a median of 6.9 years (interquartile range, 3.5-11.1 years). Their mean age at the index admission with cirrhosis was 61.2 years (standard deviation, 13.0 years), 14 895 were men (66.1%), and the most frequent causes of cirrhosis were alcohol use (9550 people, 42.4%), metabolic dysfunction-associated steatotic liver disease (MASLD; 5108 people, 22.7%), and chronic hepatitis C virus (HCV) infection (4780 people, 21.2%). A total of 12 387 people (55.0%) had died by 31 December 2022; overall mortality among people with alcohol-related cirrhosis was 57.9%, with MASLD cirrhosis 52.1%, and with HCV-related cirrhosis 51.6%. The proportions of deaths attributed to liver disease were larger for people who experienced decompensation during follow-up than those who did not (alcohol-related cirrhosis: 2538 of 3890 deaths [65.2%] v 523 of 1637 [31.9%]; HCV-related cirrhosis: 1158 of 1714 deaths [67.6%] v 331 of 753 [44.0%]). Ten-year liver-related mortality was highest among people with alcohol-related cirrhosis (48.8%; 95% confidence interval [CI], 47.2-50.4%) or HCV-related cirrhosis (44.3%; 95% CI, 42.3-46.3%); ten-year extrahepatic cancer mortality (18.8%; 95% CI, 16.8-20.9%) and cardiovascular disease mortality (15.6%; 95% CI, 13.8-17.7%) were highest among people with MASLD cirrhosis. In multivariable competing risks regression analyses, people with MASLD cirrhosis were less likely than people with alcohol-related cirrhosis to die of liver disease (adjusted subdistribution hazard ratio [sHR], 0.55; 95% CI, 0.51-0.60) and more likely to die of extrahepatic cancer (adjusted sHR, 1.21; 95% CI, 1.04-1.41).

conclusionsMortality among people who have been hospitalised with cirrhosis is high, and there is substantial variation in cause-specific mortality by cirrhosis aetiology. Care for these patients could be improved by identifying chronic liver disease earlier, and by treating cardiovascular disease and extrahepatic malignancies in people with MASLD.