Introduction: Cirrhosis of the liver is associated with increased morbidity and mortality. There is paucity of data on the etiological profile of cirrhosis in Punjab. The purpose of this study was to evaluate the etiological profile of liver cirrhosis in adults in a tertiary care institute in northern India.
Materials and methods: This study included all adult patients with cirrhosis admitted to the Gastroenterology unit of a tertiary care institute in northern India from January 2013 to December 2016. The diagnosis of cirrhosis was made based on the clinical, radiological, biochemical, and/or histological criteria. Patients with incomplete etiological workup were excluded.
Results: A total of 716 hospitalized patients with cirrhosis were included. The mean age of patients was 54 ± 9.3 years (18–82 years), and male:female ratio was 5.7:1. Most common etiologies of cirrhosis were: alcohol (49.2%; n = 352), hepatitis C virus (HCV) infection (29.4%; 211), and nonalcoholic fatty liver disease (NAFLD) (13.6%; 98). Hepatitis B virus (HBV) infection was identified in 3.9% (n = 28) patients only. Other uncommon causes of cirrhosis were: autoimmune (n = 8; 1.1%), Wilson’s disease (n = 5; 0.7%), celiac disease (n = 3; 0.4%), Budd–Chiari syndrome (BCS) (n = 1; 0.1%), and cryptogenic (n = 10; 1.4%).
Conclusion: In this study, alcohol and HCV infection were the most common causes of cirrhosis. Preventive measures are urgently required to control these factors to decrease morbidity and mortality.
Thulstrup AM, Sorensen HT, Schonheyder HC, Moller JK, Tage-Jensen U. Population-based study of the risk and shortterm prognosis for bacteremia in patients with liver cirrhosis. Clin Infect Dis 2000 Dec;31(6):1357-1361.
Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012 Dec;380(9859):2197-2223.
Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012 Dec;380(9859): 2095-2128.
Tanaka H, Tsukuma H, Yamano H, Oshima A, Shibata H. Prospective study on the risk of hepatocellular carcinoma among hepatitis C virus-positive blood donors focusing on demographic factors, alanine aminotransferase level at donation and interaction with hepatitis B virus. Int J Cancer 2004 Dec;112(6):1075-1080.
Mokdad AA, Lopez AD, Shahraz S, Lozano R, Mokdad AH, Stanaway J, Murray CJ, Naghavi M. Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis. BMC Med 2014 Sep;12:145.
D’Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systemic review of 118 studies. J Hepatol 2006 Jan;44(1):217-231.
Sarin SK, Chari S, Sundaram KR, Ahuja RK, Anand BS, Broor SL. Young v adult cirrhotics: a prospective, comparative analysis of the clinical profile, natural course and survival. Gut 1988 Jan;29(1):101-107.
Ray G, Ghoshal UC, Banerjee PK, Pal BB, Dhar K, Pal AK, Biswas PK. Aetiological spectrum of chronic liver disease in eastern India. Trop Gastroenterol 2000 Apr-Jun;21(2):60-62.
Trimukhe R, Rai R, Narayankar SM, Shewale S, Jagtap N, Rai S, Parashar MK. Epidemiological spectrum of chronic liver disease in eastern Madhya Pradesh India. J Assoc Physicians India 2011 Jan;59:48.
Sharma B, Marwah R, Raina S, Sharma N, Kaushik M, Kaushal SS. A study on the etiology of cirrhosis of liver in adults living in the Hills of Himachal Pradesh, India. Trop Gastroenterol 2016 Jan;37(1):37-41.
Mukherjee PS, Vishnubhatla S, Amarapurkar DN, Das K, Sood A, Chawla YK, Eapen CE, Boddu P, Thomas V, Varshney S, et al. Etiology and mode of presentation of chronic liver diseases in India: a multi centric study. PLoS One 2017 Oct;12(10):e0187033.
WHO. Global status report on alcohol and health 2014. Geneva: WHO; 2014. Available from: www.who.int/substance_ abuse/publications/global_alcohol_report/en/.
Chavan BS, Arun P, Bhargava R, Singh GP. Prevalence of alcohol and drug dependence in rural and slum population of Chandigarh: a community survey. Indian J Psychiatry 2007 Jan;49(1):44-48.
European Association for the Study of the Liver. EASL recommendations on treatment of hepatitis C 2016. J Hepatol 2016 Jan;66(1):153-194.
Sood A, Sarin SK, Midha V, Hissar S, Sood N, Bansal P, Bansal M. Prevalence of hepatitis C virus in a selected geographical area of northern India: a population based survey. Indian J Gastroenterol 2012 Sep;31(5):232-236.
Chakraborty A, Pramanik SB, Roy DS, Sarkar S, Chakraborty M, Nandi A. A retrospective study on the sero-prevalence of hepatitis C infection in a tertiary care hospital in Kolkata, India. Int J Curr Microbiol App Sci 2015;4(3):115-123.
Rajani M, Jais M. Age-wise seroprevalence of hepatitis C virus infection in clinically suspected infectious hepatitis patients attending a tertiary care hospital in Delhi. Int J Med Pub Health 2014 Jan-Mar;4(1):78-81.
Duseja A, Singh SP, Saraswat VA, Acharya SK, Chawla YK, Chowdhury S, Dhiman RK, Jayakumar RV, Madan K, Misra SP, et al. Non-alcoholic fatty liver disease and metabolic syndrome-position paper of the Indian National Association for the Study of the Liver, Endocrine Society of India, Indian College of Cardiology and Indian Society of Gastroenterology. J Clin Exp Hepatol 2015 Mar;5(1):51-68.
Tandon BN, Acharya SK, Tandon A. Epidemiology of hepatitis B virus infection in India. Gut 1996;38(Suppl 2):S56-S59.