Characterization of chronic liver disease, cirrhosis, and hepatocellular carcinoma progression in a Colombian health maintenance organization: a ten-year retrospective study
DOI:
https://doi.org/10.59093/27112330.134Keywords:
chronic liver disease, hepatocellular carcinoma, cirrhosis, etiology, disease progression, survival rate.Abstract
Introduction. Chronic liver disease, cirrhosis, and hepatocellular carcinoma represent a substantial burden for Colombia’s health system. This study evaluated patients' prevalence, progression, transition, and survival rates with these pathologies in a Colombian health maintenance organization. Methodology. This retrospective study, conducted between 2012 and 2022, identified patients with chronic liver disease, cirrhosis, and hepatocellular carcinoma through the International Classification of Diseases, 10th edition. The primary approach was to examine the 5- and 10-year survival rates of patients with cirrhosis and hepatocellular carcinoma. Results. The study included 33,315 patients with chronic liver disease, mainly caused by fatty liver disease (82.98%) and chronic viral hepatitis (5.18%). Of these, 1,021 developed cirrhosis, and 67 progressed to hepatocellular carcinoma. The incidence rate was 165.03 per 10,000 patients. The probabilities of progression from chronic liver disease to cirrhosis at 5 and 10 years were 4% and 7%, respectively, and from cirrhosis to hepatocellular carcinoma were 6% at 5 years and 20% at 10 years. The 5- and 10-year survival rates for cirrhosis were 80% and 63%, while for hepatocellular carcinoma they were 34% and 23%, respectively. Conclusion. The main cause of chronic liver disease in Colombia is steatotic liver disease which could be related to metabolic comorbidities. On the other hand, advanced liver conditions carry a significant risk of disease progression and reduced survival rate.
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Sharma A, Nagalli S. Chronic liver disease. En: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024. Disponible en: http://www.ncbi.nlm.nih.gov/books/NBK554597/.
McGlynn KA, Petrick JL, El-Serag HB. Epidemiology of hepatocellular carcinoma. Hepatology 2021;73:4-13. https://doi.org/10.1002/hep.31288.
Oh JH, Jun DW. The latest global burden of liver cancer: A past and present threat. Clin Mol Hepatol 2023;29:355-357. https://doi.org/10.3350/cmh.2023.0101.
Motola-Kuba D, Zamora-Valdés D, Uribe M, Méndez-Sánchez N. Hepatocellular carcinoma. An overview. Ann Hepatol 2006;5:16-24. https://doi.org/10.1016/S1665-2681(19)32030-6.
Bejarano-Ramírez DF, Carrasquilla-Gutiérrez G, Porras-Ramírez A, Vera-Torres A. Prevalence of liver disease in Colombia between 2009 and 2016. JGH Open 2020;4:603-610. https://doi.org/10.1002/jgh3.12291.
Giraldo-Montoya ÁM, Barraza-Amador M, Villa Velásquez H, Martínez JW, García-Castro G. Caracterización epidemiológica de pacientes con cirrosis en una consulta de gastroenterología en Pereira, Colombia, 2009-2012. Rev Médica Risaralda 2014;20:86-94.
Vélez-Aguirre JD, Lepesqueur-Guillén L, Yepes-Barreto I. La esteatohepatitis no alcohólica: una causa emergente de cirrosis en Colombia. Rev Colomb Gastroenterol 2022;37:136-143. https://doi.org/10.22516/25007440.850.
Al Kaabi H, Al Alawi AM, Al Falahi Z, Al-Naamani Z, Al Busafi SA. Clinical characteristics, etiology, and prognostic scores in patients with acute decompensated liver cirrhosis. J Clin Med 2023;12:5756. https://doi.org/10.3390/jcm12175756.
D’Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol 2006;44:217-231. https://doi.org/10.1016/j.jhep.2005.10.013.
Devarbhavi H, Asrani SK, Arab JP, Nartey YA, Pose E, Kamath PS. Global burden of liver disease: 2023 update. J Hepatol. 2023;79(2):516-37. https://doi.org/10.1016/j.jhep.2023.03.017.
Asrani SK, Devarbhavi H, Eaton J, Kamath PS. Burden of liver diseases in the world. J Hepatol 2019;70:151-171. https://doi.org/10.1016/j.jhep.2018.09.014.
Sepanlou SG, Safiri S, Bisignano C, Ikuta KS, Merat S, Saberifiroozi M, et al. The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol 2020;5:245-266. https://doi.org/10.1016/S2468-1253(19)30349-8.
Rinella ME, Lazarus JV, Ratziu V, Francque SM, Sanyal AJ, Kanwal F, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology 2023;78:1966-1986. https://doi.org/10.1097/HEP.0000000000000369.
Fouad Y. Metabolic-associated fatty liver disease: New nomenclature and approach with hot debate. World J Hepatol 2023;15:123-128. https://doi.org/10.4254/wjh.v15.i2.123.
Shah PA, Patil R, Harrison SA. NAFLD-related hepatocellular carcinoma: The growing challenge. Hepatology 2023;77:323-338. https://doi.org/10.1002/hep.32385.
Le MH, Yeo YH, Li X, Li J, Zou B, Wu Y, et al. 2019 Global NAFLD prevalence: A systematic review and meta-analysis. Clin Gastroenterol Hepatol 2022;20:2809-2817.e28. https://doi.org/10.1016/j.cgh.2020.12.022.
Lazarus JV, Mark HE, Anstee QM, Arab JP, Batterham RL, Castera L, et al. Advancing the global public health agenda for NAFLD: a consensus statement. Nat Rev Gastroenterol Hepatol 2022;19:60-78. https://doi.org/10.1038/s41575-021-00523-4.
Calzadilla Bertot L, Adams LA. The natural course of non-alcoholic fatty liver disease. Int J Mol Sci 2016;17:774. https://doi.org/10.3390/ijms17050774.
Khoo T, Lam D, Olynyk JK. Impact of modern antiviral therapy of chronic hepatitis B and C on clinical outcomes of liver disease. World J Gastroenterol 2021;27(29):4831-4845. https://doi.org/10.3748/wjg.v27.i29.4831.
Huang DQ, Terrault NA, Tacke F, Gluud LL, Arrese M, Bugianesi E, et al. Global epidemiology of cirrhosis - Aetiology, trends and predictions. Nat Rev Gastroenterol Hepatol. 2023 Jun;20(6):388-398. https://doi.org/10.1038/s41575-023-00759-2.
Cheemerla S, Balakrishnan M. Global epidemiology of chronic liver disease. Clin Liver Dis 2021;17:365-370. https://doi.org/10.1002/cld.1061.
Castera L, Cusi K. Diabetes and cirrhosis: Current concepts on diagnosis and management. Hepatology 2023;77:2128-2146. https://doi.org/10.1002/hep.32690.
Kasper P, Martin A, Lang S, Kütting F, Goeser T, Demir M, et al. NAFLD and cardiovascular diseases: a clinical review. Clin Res Cardiol 2021;110:921-937. https://doi.org/10.1007/s00392-021-01831-1.
Tilg H, Moschen AR, Roden M. NAFLD and diabetes mellitus. Nat Rev Gastroenterol Hepatol 2017;14:32-42. https://doi.org/10.1038/nrgastro.2016.147.
Powell EE, Wong VW, Rinella M. Non-alcoholic fatty liver disease. Lancet 2021;397:2212-2224. https://doi.org/10.1016/S0140-6736(20)32511-3.
Liu YB, Chen MK. Epidemiology of liver cirrhosis and associated complications: Current knowledge and future directions. World J Gastroenterol 2022;28:5910-5930. https://doi.org/10.3748/wjg.v28.i41.5910.
Anstee QM, Reeves HL, Kotsiliti E, Govaere O, Heikenwalder M. From NASH to HCC: current concepts and future challenges. Nat Rev Gastroenterol Hepatol 2019;16:411-428. https://doi.org/10.1038/s41575-019-0145-7.
Kumar R, Priyadarshi RN, Anand U. Non-alcoholic fatty liver disease: Growing burden, adverse outcomes and associations. J Clin Transl Hepatol 2020;8:76-86. https://doi.org/10.14218/JCTH.2019.00051.
Alexander M, Loomis AK, van der Lei J, Duarte-Salles T, Prieto-Alhambra D, Ansell D, et al. Risks and clinical predictors of cirrhosis and hepatocellular carcinoma diagnoses in adults with diagnosed NAFLD: real-world study of 18 million patients in four European cohorts. BMC Med 2019;17:95. https://doi.org/10.1186/s12916-019-1321-x.
Yang JD, Ahmed F, Mara KC, Addissie BD, Allen AM, Gores GJ, et al. Diabetes is associated with increased risk of hepatocellular carcinoma in patients with cirrhosis from nonalcoholic fatty liver disease. Hepatology 2020;71:907-916. https://doi.org/10.1002/hep.30959.
Anstee QM, Targher G, Day CP. Progression of NAFLD to diabetes mellitus, cardiovascular disease or cirrhosis. Nat Rev Gastroenterol Hepatol 2013;10:330-344. https://doi.org/10.1038/nrgastro.2013.41.
Xiao J, Wang F, Wong NK, Lv Y, Liu Y, Zhong J, et al. Epidemiological realities of alcoholic liver disease: Global burden, research trends, and therapeutic promise. Gene Expr 2020;20:105-118. https://doi.org/10.3727/105221620X15952617220044.
Sajja KC, Mohan DP, Rockey DC. Age and ethnicity in cirrhosis. J Investig Med 2014;62:920-926. https://doi.org/10.1097/JIM.0000000000000090.
Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2024;74:229-263. https://doi.org/10.3322/caac.21708.
Kulik L, El-Serag HB. Epidemiology and management of hepatocellular carcinoma. Gastroenterology 2019;156:477-491.e1. https://doi.org/10.1053/j.gastro.2018.08.065.
Kansagara D, Papak J, Pasha AS, O'Neil M, Freeman M, Relevo R, et al. Screening for hepatocellular carcinoma in chronic liver disease: a systematic review. Ann Intern Med 2014;161:261-269. https://doi.org/10.7326/M14-0558.
Atkins D, Ross D, Kelley M. Acting in the face of uncertainty. Ann Intern Med 2014;161:300-301. https://doi.org/10.7326/M14-1688.
Singal AG, Lampertico P, Nahon P. Epidemiology and surveillance for hepatocellular carcinoma: New trends. J Hepatol 2020;72:250-261. https://doi.org/10.1016/j.jhep.2019.08.025.
El-Serag HB, Hampel H, Javadi F. The association between diabetes and hepatocellular carcinoma: a systematic review of epidemiologic evidence. Clin Gastroenterol Hepatol 2006;4:369-380. https://doi.org/10.1016/j.cgh.2005.12.007.
Janssen A, Grobbee DE, Dendale P. Non-alcoholic fatty liver disease, a new and growing risk indicator for cardiovascular disease. Eur J Prev Cardiol 2020;27:1059-1063. https://doi.org/10.1177/2047487319872413.
Adams LA, Anstee QM, Tilg H, Targher G. Non-alcoholic fatty liver disease and its relationship with cardiovascular disease and other extrahepatic diseases. Gut 2017;66:1138-1153. https://doi.org/10.1136/gutjnl-2017-313884.
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