Cause-specific mortality among Queensland people with cirrhosis, by cirrhosis aetiology and decompensation status, 2007-22: a retrospective cohort study.

Objective: To determine the cumulative incidence of overall and cause-specific mortality among Queensland residents admitted to hospital with cirrhosis during 2007-22, by cirrhosis aetiology.

Study design: Retrospective cohort study; analysis of linked Queensland Hospital Admitted Patient Data Collection and Queensland Registry of Births, Deaths and Marriages data.

Setting, participants: Adult Queensland residents (18 years or older) admitted to Queensland hospitals with cirrhosis during 1 July 2007 - 31 December 2022.

Main outcome measures: Ten-year mortality, all-cause and cause-specific (liver-related, extrahepatic cancer, cardiovascular disease), by cirrhosis aetiology.

Results: A total of 22 525 people were followed for a median of 6.9 years (interquartile range, 3.5-11.1 years). Their mean age at the index admission with cirrhosis was 61.2 years (standard deviation, 13.0 years), 14 895 were men (66.1%), and the most frequent causes of cirrhosis were alcohol use (9550 people, 42.4%), metabolic dysfunction-associated steatotic liver disease (MASLD; 5108 people, 22.7%), and chronic hepatitis C virus (HCV) infection (4780 people, 21.2%). A total of 12 387 people (55.0%) had died by 31 December 2022; overall mortality among people with alcohol-related cirrhosis was 57.9%, with MASLD cirrhosis 52.1%, and with HCV-related cirrhosis 51.6%. The proportions of deaths attributed to liver disease were larger for people who experienced decompensation during follow-up than those who did not (alcohol-related cirrhosis: 2538 of 3890 deaths [65.2%] v 523 of 1637 [31.9%]; HCV-related cirrhosis: 1158 of 1714 deaths [67.6%] v 331 of 753 [44.0%]). Ten-year liver-related mortality was highest among people with alcohol-related cirrhosis (48.8%; 95% confidence interval [CI], 47.2-50.4%) or HCV-related cirrhosis (44.3%; 95% CI, 42.3-46.3%); ten-year extrahepatic cancer mortality (18.8%; 95% CI, 16.8-20.9%) and cardiovascular disease mortality (15.6%; 95% CI, 13.8-17.7%) were highest among people with MASLD cirrhosis. In multivariable competing risks regression analyses, people with MASLD cirrhosis were less likely than people with alcohol-related cirrhosis to die of liver disease (adjusted subdistribution hazard ratio [sHR], 0.55; 95% CI, 0.51-0.60) and more likely to die of extrahepatic cancer (adjusted sHR, 1.21; 95% CI, 1.04-1.41).

Conclusions: Mortality among people who have been hospitalised with cirrhosis is high, and there is substantial variation in cause-specific mortality by cirrhosis aetiology. Care for these patients could be improved by identifying chronic liver disease earlier, and by treating cardiovascular disease and extrahepatic malignancies in people with MASLD.