O20 Characteristics and outcomes of first emergency admissions for alcohol-related liver disease: linkage analysis of the English CPRD population, 2008–2017

IntroductionAlcohol-related liver disease (ARLD) often presents for the first time as an emergency hospital admission. We examined time trends in characteristics, care processes and case fatality rates of first admissions for ARLD in England.MethodsNational population-based, observational study using CPRD-HES-ONS data, 2008/9–17/18. First emergency admissions ≥18 yrs were identified using Liverpool ARLD coding algorithm.1 Covariates: age, sex, deprivation status, case definition (coding pattern), stage of ARLD, non-liver comorbidity, coding for ascites and varices. We applied stratified survival analyses and binary logistic regression models to assess case-mix-adjusted associations between date of discharge and death.Results17,575 first admissions (mean age: 53; 33% female; 32% from most deprived quintile; 47% with non-primary coding pattern; 13% with hepatic failure [HF]). During the year before admission, only 47% of GP consulters had alcohol-related problems documented (liver disease in just 14.7%) and alcohol-specific diagnoses were absent from 24% of prior emergency admission records. Case fatality rate was 15% in-hospital (HF: 39%) and 34% at one year (HF: 56%). Case-mix-adjusted odds of dying during index hospitalization reduced by 6% per year (aOR: 0.94; 95% CI: 0.93–0.96) and 4% per year at 365 days (aOR: 0.96; 95% CI: 0.95–0.97). There were regional variations in providing higher level care and in case fatality rates.ConclusionsDespite improved prognosis of first admissions we found missed opportunities for earlier diagnosis in primary and secondary care. In 2017/18, one in seven were still dying during first hospitalisation, rising to one third within a year. Geographic inequalities require further investigation. Nationwide efforts are needed to promote earlier detection and intervention. (Funding: UK Department of Health - Connected Health Cities).ReferenceDhanda A, Bodger K, et al. The liverpool alcohol-related liver disease algorithm identifies twice as many emergency admissions compared to standard methods when applied to Hospital Episode Statistics for England. Aliment Pharmacol Ther. 2023 Feb;57(4):368–377.