Early diagnosis and intervention could prevent death from alcohol-related liver disease

Patients dying from alcohol-related liver disease had frequent interactions with secondary care services before their death, and a new study found these opportunities to address their high-risk drinking behavior could have been missed.

The research found that people who died of alcohol-related liver disease (ARLD) had an average of 25 interactions with Nottinghamshire hospitals before they died.

The study, published in the Drug And Alcohol Review, was led by Dr Mohsen Subhani and Rebecca Elleray, from the University of Nottingham School of Medicine.

Alcohol-related liver disease (ARLD) is a preventable cause of death. In 2020 in the UK, the alcohol-related death rate was the highest reported since 2001, with an increase of 19.6% compared to 2019. In 2018, the World Health Organization reported that alcohol consumption had contributed to more than 3 million deaths (2.3 million males, 2.3 million females). 0.7 million) and 132.6 million disability-adjusted life years (DALYs) worldwide per year.

ARLD is asymptomatic in the early stages and often presents late when the prognosis is poor. Early identification of alcohol abuse is therefore essential and, as noted, there may be many opportunities to identify alcohol abuse and/or diagnose ARLD earlier.

There has been little research describing where and how patients with underlying ARLD interacted with healthcare professionals. Little is also known about the specific factors associated with delayed diagnosis. The studies lacked a detailed assessment linked to health-related contacts before death, which limits the understanding of intervention possibilities.

In this new study, experts sought to analyze retrospective data from the Office for National Statistics (ONS) and Hospital Episode Statistics (HES) databases to identify adult residents (over the age of 18 ) from Nottinghamshire who died from ARLD over a 5 year period (between January 2012 and 31 December 2017). Death was used as the primary outcome and analysis was performed to test the association between key variables and ARLD mortality.

Over 5 years, 799 ARLD deaths have been recorded. More than half had no diagnosis or a diagnosis of ARLD less than 6 months before death.

ED presentation at first diagnosis of ARLD and white ethnicity were significantly associated with delayed diagnosis. Overall, the cohort had a median of 5 hospital admissions, 4 accident and emergency visits, and 16 outpatient appointments in the 5 years prior to death. Treatment was provided by a range of specialties, with general practice being the most common. Alcohol was associated with most admissions.

Our study shows that people with ARLD had an average of 25 interactions with Nottinghamshire hospitals before they died.


These interactions have occurred primarily in ambulatory patients, and more than 50% of patients were only diagnosed with liver disease within the last six months prior to death.


These data clearly highlight the shortcomings of ARLD secondary care and underline the importance of the message from Health and Education England and NICE that “every contact matters” and “alcohol testing and counseling is the responsibility of every healthcare professional. We now have a powerful methodology that can be used to assess and improve how alcohol problems are managed and where actions can be better targeted.”


Dr. Mohsen Subhani, corresponding author of the study

Source:

Journal reference:

Subhani, M. et al. (2022) Mortality from alcohol-related liver disease and missed opportunities in secondary care: a retrospective observational study from the UK. Drug and alcohol review. doi.org/10.1111/dar.13482.

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