Three in four people are first diagnosed with liver disease during an emergency hospital admission, according to a major national study published in the European Journal of Internal Medicine . The study found that almost 60% of these patients die within five years of that first admission, highlighting the devastating consequences of late diagnosis and survival rates that are worse than those seen in many cancers.
The research, which analysed data from 82,402 people admitted to hospital as an emergency with chronic liver disease in England, found that emergency admission is often the first point at which liver disease is identified. Researchers estimate that around 10,000 people each year experience a first emergency admission for chronic liver disease, making earlier diagnosis one of the biggest opportunities to improve outcomes and save lives.
Professor William Bernal, from King’s College Hospital NHS Trust who led the study said:
“One of the most striking findings is that emergency admission is frequently the first point at which chronic liver disease is recognised. By the time patients present in this way, their disease is often advanced, and the consequences are severe. Nearly 60% of patients in our study died within five years, despite many being of working age and having few other serious health conditions. These outcomes are comparable to, and in some cases worse than, those seen in many cancers.”
Of the 82,402 patients included in the study, 59.9% died within five years of their first emergency admission, with median survival of just 2.7 years. Researchers describe emergency admission as a critical event associated with exceptionally poor long-term outcomes.
The research, led by academics from King’s College Hospital, King’s College London and the London School of Hygiene & Tropical Medicine as part of the NIHR-funded MAP-CLD programme, also revealed significant geographical inequalities in outcomes. Patients living in all regions outside London faced a higher risk of death, even after taking account of factors such as age, disease severity and underlying cause of liver disease. Outcomes were particularly poor in parts of northern England and the Midlands.
Alcohol-related liver disease was the most common cause of emergency admissions, accounting for more than half of all cases and was associated with poorer outcomes than most other liver disease types. Patients who developed serious complications such as fluid build-up in the abdomen (ascites) and confusion or changes in brain function (hepatic encephalopathy) caused by advanced liver disease were at significantly greater risk of death.
The study also found evidence that access to specialist care makes a difference. Patients who were treated by a hepatologist or gastroenterologist had better survival outcomes, yet nearly half of patients were not under the care of a liver specialist during their first emergency admission.
Pamela Healy, Chief Executive of Liver UK, the new name for the British Liver Trust, said: “These findings show the human cost of diagnosing liver disease too late. For around three-quarters of people, an emergency hospital admission is the first time their liver disease comes to the attention of hospital services. By then, many are seriously unwell and their long-term outlook is dramatically worse.
“Liver disease can often be prevented, treated and managed if it is found early enough. We need much greater focus on identifying people at risk, particularly people who drink at harmful levels and people living with obesity and type 2 diabetes, before they reach crisis point.
No one should have their liver disease diagnosed for the first time in an emergency department. Earlier diagnosis, better access to specialist care and action to tackle inequalities in outcomes could save lives.”
Professor William Bernal, from King’s College Hospital NHS Trust who led the study continued:
“The findings show that outcomes are influenced not only by the severity and cause of liver disease, but also by where patients live and whether they have access to specialist liver care. These are factors that the healthcare system can address.
The message from this study is clear. We need to move away from a model focused largely on responding to crisis and advanced disease and place much greater emphasis on prevention, early diagnosis and long-term management. That is where the greatest gains in survival and quality of life can be achieved.”
The study forms part of the wider MAP-CLD (Management of Patients Admitted with Chronic Liver Disease) programme, which is examining the burden, outcomes, inequalities and lived experience of chronic liver disease across England. Across the programme, researchers have consistently found that emergency admission is associated with poor outcomes and that greater gains could be achieved through earlier diagnosis, improved access to specialist care, reductions in regional inequalities and a stronger focus on prevention and long-term disease management.
