Background

• Severe, chronic, progressive fibrosis due to chronic injury, leading to liver failure and associated complications
• 11th leading cause of death of adults in the United States in 2020
  • 4.5 million adults diagnosed with liver disease (1.8% of the population)
  • Likely an underestimation of the burden of disease

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Epidemiology & Health Disparities

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• Most common causes in the US:
  • Alcohol Use Disorder
  • Viral Hepatitis (Hepatitis B and C)
  • Fatty Liver Disease
    • Nonalcoholic steatohepatitis (NASH)
    • Nonalcoholic fatty liver disease (NAFLD)
• These causes account for approximately 80% of the patients on the liver transplant waitlist between 2003-2014
  • Second longest organ waitlist in the United States (second to kidney transplantation)

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Additional Causes

• Infection
• Autoimmune
• Hemochromatosis
• Medications

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Categorizing Cirrhosis

Mortality

• Much higher in those with cirrhosis
  • 26.4% per two-year interval in those with cirrhosis versus 8.4% in propensity-matched controls
• Significant differences when comparing compensated and decompensated cirrhosis
  • Risk of death:
    • Compensated: 4.7 times higher than the general population
    • Decompensated: 9.7 times higher than the general population
  • Life expectancy:
    • Compensated: 10-13 years
    • Decompensated: as little as 2 years

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Financial Burden

• Continuing to rise due to cirrhosis and associated complications requiring hospitalization
  • Estimated direct and indirect costs to be in the billions
  • As hospitalizations go up, so does the cost burden on the healthcare system
• Extended length of stay, medications, and need for emergent procedures all increase cost in this patient population
• Chronic liver disease patients have also been shown to have
  • Longer admissions
  • More readmissions
  • Less access to care than in other disease states

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Pathophysiology Overview