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The prevalence of chronic liver disease and the resulting cirrhosis is increasing in various countries around the world. In the United States, between approximately 1990 and 2010 we have observed an overall increase in the prevalence of chronic liver disease to 15% of the entire population,1 and with that a 43% increase in deaths due to cirrhosis and a 118% increase in deaths due to hepatocellular carcinoma (HCC).2 With cirrhosis comes the increased risk of complications that require hospitalization, which are often prolonged, expensive, and have a high mortality. In this context, Kim and colleagues3 describe the complications requiring hospital admission and causes of death in 2,165 patients from five referral hospitals in South Korea for the years of 2002 and 2011. The study is notable for several major findings. First, despite the fact that hepatitis B is the most common cause of cirrhosis in Korea, the majority of patients hospitalized for cirrhotic complications had cirrhosis due to alcohol in 2002 (52%), which decreased only slightly in 2011 (49%). Second, the major causes of hospitalizations in the earlier time period were variceal bleeding followed by hepatic encephalopathy (HE), ascites, and hepatic failure; whereas in the later time period there was a relative reduction in HE and spontaneous bacterial peritonitis (SBP), with an increase in hepatocellular cancer and hepatorenal syndrome (HRS). Third, they observed little change in hospital mortality, 8.6% in 2002 to 9.1% in 2011. Interestingly, the trend over time for cause of hospital death decreased for variceal bleeding, HE, and SBP, but increased for the more end stage causes of hepatic failure and HRS; changes that were most striking for patients with alcoholic cirrhosis. These findings are obviously limited by the known limitations of retrospective medical record data extraction, and more data related to Model for End-stage Liver Disease or Child-Pugh scores, length of hospitalization, and readmissions would have been useful. The strength of the study is the relatively large number of patients from five referral centers that would be broadly representative of similar referral centers in countries with universal combined government and private insurance.

Changes in Hospital Admissions and Mortality for Complications of Cirrhosis: Implications for Clinicians and Health Systems