Incidence of hepatocellular carcinoma and cirrhotic complications in patients with psychiatric illness: A territory-wide cohort study
Refereed conference paper presented and published in conference proceedings


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AbstractBackground and aims: Because of high-risk behaviours, psychiatric patients are at risk of viral hepatitis and alcohol-related liver disease. Their sedentary lifestyle and side effects of psychiatric medicine are also conducive to obesity and non-alcoholic fatty liver disease. We aim to study the incidence of hepatocellular carcinoma (HCC) and cirrhotic complications in a territory-wide cohort of psychiatric patients in Hong Kong.

Method: We identified patients with psychiatric diagnoses from 2003 to 2007 using the Clinical Data Analysis and Reporting System. This system captures in-patient and out-patient data of all public hospitals and clinics in Hong Kong. The patients were followed for liver-related events (HCC and cirrhotic complications) and deaths until December 2017.

Results: Of 178, 225 psychiatric patients, we included 105, 763 adult patients without prior HCC and cirrhotic complications in the final analysis. During a median follow-up of 12.4 (interquartile range 11.0- 13.7) years, 1, 520 (1.4%) patients developed HCC and/or cirrhotic complications (Figure). Compared with the general population, psychiatric patients had increased incidence of HCC (standardized incidence ratio [SIR] 1.70, 95% CI 1.54-1.87). The SIR was highest in patients with alcohol-related (SIR 3.48) and drug-induced mental disorders (SIR 3.34), but was also increased in patients with psychotic disorders (SIR 1.58) and mood disorders (SIR 1.48). Liver disease was the fifth most common cause of death in this population, accounting for 603 of 10, 614 (5.7%) deaths. Chronic hepatitis B (n = 375, 24.7%), chronic hepatitis C (n = 175, 11.5%), alcohol-related liver disease (n = 190, 12.5%) and non-alcoholic fatty liver disease (n = 78, 5.1%) were the leading aetiologies in patients with liver-related events. Importantly, 799 (52.6%) patients were not known to have liver diseases at the time of liver-related events.

Conclusion: HCC, cirrhotic complications and liver-related deaths are common in psychiatric patients, but liver diseases are often undiagnosed. More efforts are needed to identify liver diseases in the psychiatric population so that treatments and screening for HCC and varices can be provided to patients in need.
All Author(s) ListWong VWS, Yip TCF, Tse YK, Yuen BWY, Luk HWS, Lam MHB, Li MKK, Loo CK, Tsang TYO, Tsang SWC, Chan HLY, Wing YK, Wong GLH
Name of ConferenceEuropean Association for the Study of the Liver (EASL) The International Liver Congress™ 2019
Start Date of Conference10/04/2019
End Date of Conference14/04/2019
Place of ConferenceVienna
Country/Region of ConferenceAustria
Proceedings TitleJournal of Hepatology
Title of PublicationJOURNAL OF HEPATOLOGY
Year2019
Month4
Volume Number70
Issue NumberSuppl 1
PublisherELSEVIER SCIENCE BV
PagesE693 - E693
ISSN0168-8278
eISSN1600-0641
LanguagesEnglish-United Kingdom
Web of Science Subject CategoriesGastroenterology & Hepatology;Gastroenterology & Hepatology

Last updated on 2021-09-06 at 01:04