Survey of alcohol-related cirrhosis at a tertiary care center in North East India.

Abstract

Alcohol use is increasing in North East India and is important to estimate the influence of these changes in the epidemiology of alcohol related cirrhosis. Among 1000 consecutive patients of cirrhosis, diagnosed by a combination of clinical, radiological and/or histopathological features, etiology was established by history of significant alcohol abuse, determining viral and autoimmune markers and by metabolic screening. Patients not confirmed to be cirrhotic were excluded from the study. All cases were studied to determine clinical features, complications, disease prognosis, and mortality. Alcoholic cirrhotics were then compared with nonalcohol etiology. 72.2% alcoholic cirrhosis were compared with 27.8% patients of nonalcohol etiology and alcoholic cirrhotics were younger (45 + 9.4years vs. 47.9 + 12.5years), predominantly males (M/F ratio 37:1 vs. 1.8:1) with significantly high incidence of jaundice (38.5% vs. 30.5%), night blindness (14.4% vs. 3.6%), ascites (76.3% vs. 69.1%), upper gastrointestinal bleed (46.4% vs. 34.5%), and hepatic encephalopathy (24.1% vs. 10.4%). Biochemical parameters that were significantly higher in alcoholics were mean bilirubin (4.7 + 8.7 vs. 3.1 + 4.7mg/dL), AST/ALT ratio (2.03 vs. 1.4), gamma-glutaryl transaminase levels (209.7 + 37.9 vs. 93.9 + 14IU/mL), and serum ammonia (75.1 + 55.7 vs. 52.1 + 45.4mg/dL). Mean model for end-stage liver disease, scores, and Child C disease was significantly higher in alcoholics (18.6 + 7.7 vs. 15.6 + 6.4) and (54.1% vs. 37%), respectively, representing advanced disease at presentation. Mortality within 1month was significantly higher among alcoholic cirrhosis (9.8% vs. 3.2%). Thus, alcoholic cirrhosis is of major concern in North East India as majority patients are in most productive age group and presented with advanced disease. Short-term mortality was high among alcoholic cirrhotics. Proper education and legislation are essential to mitigate the consequences of this disease.