Aetiology and outcomes of emergency admissions for chronic liver disease in England, 2012–2019: a national cohort study using administrative data
Jessica King, Cori Campbell, Vikram Bains, James Doidge, Jan Van Der Meulen, Kate Walker, William BernalObjective
Chronic liver disease (CLD) deaths in the UK have risen fivefold since 1970. People with CLD often present with advanced disease. We investigated trends in aetiology, care, and outcomes of patients with a first emergency admission (FEA) for CLD in England.
Methods
In a retrospective cohort study, we analysed national administrative data of hospital admissions (Hospital Episode Statistics Admitted Patient Care data) to identify patients with a FEA for CLD between April 2012 and March 2019. We used negative binomial, logistic and proportional hazards regression to explore time trends in admission numbers according to population size, demographics, aetiology, readmissions, mortality, transplantation, and the treating clinicians’ specialty.
Results
There were 83 527 FEAs for CLD during the 7-year study period, with numbers increasing each year. There was no evidence of a time trend when population size was taken into account (p=0.51). Of these FEAs, 65.3% had alcohol-related aetiologies. The proportion of FEAs with viral aetiologies decreased (7.3% in 2012–2014 vs 5.6% in 2016–2019; p<0.001) and metabolic dysfunction-associated steatotic liver disease (MASLD) increased (5.8–11.3%; p<0.001), respectively. Mortality within 30 days was 17.3% and 37.3% within 1 year. 1-year all-cause mortality improved over the study period (2012–2014 vs 2016–2018 adjusted HR 0.92 (95% CI 0.90 to 0.95)) but 30-day readmission rate increased (1.04 (95% CI 1.00 to 1.09)). Over 40% of patients did not receive care from a hepatologist/gastroenterologist during the FEA and <1% received liver transplant within 1 year.
Conclusion
The number of patients with FEA for CLD increased in line with population size between 2012 and 2019. The dominant aetiology was alcohol-related, but the proportion with MASLD nearly doubled over the study period. There were improvements in survival, but over a third of patients died within a year, and over a third of hospital survivors were readmitted. Many patients did not receive specialist inpatient care or evidence-based interventions, suggesting opportunities to improve survival and resource use.