- High long-term mortality after first emergency admission: 59.9% died within 5 years; median survival 2.72 years.
- Mortality higher with older age, male sex, comorbidity, and severe complications; alcohol-related aetiology worse than metabolic or autoimmune (adjHRs 0.76-0.82).
- Marked geographic disparities: higher mortality in all eight regions outside London; urgent need for targeted treatments and healthcare resource review.
Eur J Intern Med. 2026 Aug 24:107142. doi: 10.1016/j.ejim.2026.107142. Online ahead of print.
ABSTRACT
BACKGROUND: Chronic liver disease (CLD) is a growing global health concern. Many CLD patients experience an emergency hospital admission, after which prognosis is often poor. We studied long-term mortality and its key determinants in first emergency admissions (FEA) for CLD in England.
METHODS: CLD patients with a FEA between April 2012 and March 2019 were identified in national administrative hospital data, with minimum 5 years follow-up. Proportional hazards modelling was used to estimate adjusted hazard ratios (adjHR) for all-cause mortality according to patient characteristics, aetiology, disease severity, and region of residence.
FINDINGS: Of 82,402 CLD patients, 49,398 (59·9%) died within 5 years of FEA. Median survival was 2·72 (95%CI 2·66-2·79) years. Five-year mortality was higher in older patients, men, and those with comorbid conditions. Compared to patients with alcohol-related liver disease, mortality was lower in those with metabolic (adjHR 0·76; 0·73-0·78), combined metabolic and alcohol-related (adjHR 0·80; 0·78-0·82) and autoimmune disease (adjHR 0·82; 0·80-0·85). Manifestations of disease severity, including encephalopathy (adjHR 1·70; 1·62-1·77), ascites (adjHR 1·64; 1·61-1·67), and gastrointestinal bleeding (adjHR 1·10; 1·08-1·12), were associated with increased mortality. Mortality was higher in all eight regions outside London (adjHRs varying from 1·06 (1·02-1·11) to 1·19 (1·13-1·24)).
INTERPRETATION: Mortality of CLD patients after a FEA in England is exceptionally high, with marked differences according to sociodemographic characteristics, aetiology, disease severity, and geographic region. Treatment innovations are urgently needed, targeting those at highest risk. Healthcare resource allocation should be reviewed to address potential geographic inequities in outcome.
PMID:42637631 | DOI:10.1016/j.ejim.2026.107142
Share Evidence Blueprint
Save to Google Notes
Search Google Scholar
Save as PDF
⭐ My Revision List
