Cirrhosis is an important cause of morbidity and mortality. Cirrhosis and other chronic liver diseases are ranked as the 14th most common cause of death globally.[4]Wu XN, Xue F, Zhang N, et al. Global burden of liver cirrhosis and other chronic liver diseases caused by specific etiologies from 1990 to 2019. BMC Public Health. 2024 Feb 3;24(1):363.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10837876
http://www.ncbi.nlm.nih.gov/pubmed/38310221?tool=bestpractice.com
In 2019, about 2.4% of global deaths were due to cirrhosis.[5]Huang DQ, Terrault NA, Tacke F, et al. Global epidemiology of cirrhosis - aetiology, trends and predictions. Nat Rev Gastroenterol Hepatol. 2023 Jun;20(6):388-98.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10043867
http://www.ncbi.nlm.nih.gov/pubmed/36977794?tool=bestpractice.com
An estimated 1.5 billion people globally have chronic liver diseases, with an age-standardized incidence of chronic liver diseases and cirrhosis of 25.35 per 100,000 people in 2019.[4]Wu XN, Xue F, Zhang N, et al. Global burden of liver cirrhosis and other chronic liver diseases caused by specific etiologies from 1990 to 2019. BMC Public Health. 2024 Feb 3;24(1):363.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10837876
http://www.ncbi.nlm.nih.gov/pubmed/38310221?tool=bestpractice.com
[6]Moon AM, Singal AG, Tapper EB. Contemporary epidemiology of chronic liver disease and cirrhosis. Clin Gastroenterol Hepatol. 2020 Nov;18(12):2650-66.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7007353
http://www.ncbi.nlm.nih.gov/pubmed/31401364?tool=bestpractice.com
In 2017, the global prevalence of compensated cirrhosis was estimated to be 112 million cases and global prevalence of decompensated disease was estimated to be 10.6 million cases.[7]GBD 2017 Cirrhosis Collaborators. 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 Mar;5(3):245-66.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7026710
http://www.ncbi.nlm.nih.gov/pubmed/31981519?tool=bestpractice.com
In the US, cirrhosis affects around 2.2 million adults and is associated with mortality rates of 21.9 per 100,000 people.[3]Tapper EB, Parikh ND. Diagnosis and management of cirrhosis and its complications: a review. JAMA. 2023 May 9;329(18):1589-602.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10843851
http://www.ncbi.nlm.nih.gov/pubmed/37159031?tool=bestpractice.com
Hospital admissions related to liver cirrhosis have increased in the US, from 3056 per 100,000 hospital admissions in 2012 to 3757 per 100,000 hospital admissions in 2016.[8]Hirode G, Saab S, Wong RJ. Trends in the burden of chronic liver disease among hospitalized US adults. JAMA Netw Open. 2020 Apr 1;3(4):e201997.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7118516
http://www.ncbi.nlm.nih.gov/pubmed/32239220?tool=bestpractice.com
In the UK, cirrhosis is a significant cause of premature mortality and years of working life lost.[9]Office for Health Improvement and Disparities. Liver disease: applying All Our Health. May 2022 [internet publication].
https://www.gov.uk/government/publications/liver-disease-applying-all-our-health/liver-disease-applying-all-our-health
The majority of cases of chronic liver disease are accounted for by viral hepatitis, alcohol-related liver disease, and metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD).[7]GBD 2017 Cirrhosis Collaborators. 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 Mar;5(3):245-66.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7026710
http://www.ncbi.nlm.nih.gov/pubmed/31981519?tool=bestpractice.com
Incidence of cirrhosis due to viral hepatitis has reduced following implementation of successful vaccination programs.[6]Moon AM, Singal AG, Tapper EB. Contemporary epidemiology of chronic liver disease and cirrhosis. Clin Gastroenterol Hepatol. 2020 Nov;18(12):2650-66.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7007353
http://www.ncbi.nlm.nih.gov/pubmed/31401364?tool=bestpractice.com
[10]Lan Y, Wang H, Weng H, et al. The burden of liver cirrhosis and underlying etiologies: results from the Global Burden of Disease Study 2019. Hepatol Commun. 2023 Feb 1;7(2):e0026.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10019239
http://www.ncbi.nlm.nih.gov/pubmed/36995726?tool=bestpractice.com
The prevalence of MASLD has increased in parallel with the obesity epidemic.[10]Lan Y, Wang H, Weng H, et al. The burden of liver cirrhosis and underlying etiologies: results from the Global Burden of Disease Study 2019. Hepatol Commun. 2023 Feb 1;7(2):e0026.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10019239
http://www.ncbi.nlm.nih.gov/pubmed/36995726?tool=bestpractice.com
If this trend continues, it is expected that MASLD will become the most common cause of advanced liver disease and liver failure in the 21st century.[11]Davis GL, Roberts WL. The healthcare burden imposed by liver disease in aging Baby Boomers. Curr Gastroenterol Rep. 2010 Feb;12(1):1-6.
http://www.ncbi.nlm.nih.gov/pubmed/20425478?tool=bestpractice.com
[12]Harris R, Card TR, Delahooke T, et al. Obesity is the most common risk factor for chronic liver disease: results from a risk stratification pathway using transient elastography. Am J Gastroenterol. 2019 Nov;114(11):1744-52.
http://www.ncbi.nlm.nih.gov/pubmed/31453812?tool=bestpractice.com
In Europe, cirrhosis related to either viral infection (21% [13% hepatitis C virus infection; 7% hepatitis B virus infection]) or alcohol misuse (19%) are the main indications for liver transplant. Dual etiology liver cirrhosis caused by viral hepatitis and alcohol-related liver disease represents 3% of cases.[13]Adam R, Karam V, Delvart V, et al. Evolution of indications and results of liver transplantation in Europe. A report from the European Liver Transplant Registry (ELTR). J Hepatol. 2012 Sep;57(3):675-88.
https://www.journal-of-hepatology.eu/article/S0168-8278(12)00336-4/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/22609307?tool=bestpractice.com