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Liver cancer and hepatic decompensation events in patients hospitalized with viral hepatitis in Spain

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Abstract

Background

Chronic viral hepatitis B, C, and D are the main causes of decompensated cirrhosis and liver cancer worldwide. Newborn HBV vaccination was implemented more than 2 decades ago in most EU countries. Furthermore, potent oral antivirals have been available to treat HBV for 15 years and to cure HCV since 2014. The real-life clinical benefits of these interventions at country level have not been assessed, especially regarding major hepatic outcomes such as cirrhotic decompensation events and hepatocellular carcinoma (HCC).

Methods

Retrospective study of all hospitalizations in Spain having HBV, HCV, and HDV as diagnosis using the Spanish National Registry of Hospital Discharges. Information was retrieved from 1997 up to 2017.

Results

From a total of 73,939,642 hospital admissions during the study period, a diagnosis of HBV, HCV, and HDV was made in 124,915 (1.7‰), 981,985 (13.3‰), and 4850 (0.07‰) patients, respectively. The median age of patients hospitalized within each group was 53.2, 55.9, and 47.0 years, respectively. Significant increases in mean age at hospitalization occurred in all groups (0.6 years older per calendar year on average).

The overall rate of hepatic decompensation events for HBV, HCV, and HDV was 12.1%, 14.1%, and 18.8%, respectively. For HCC hospitalizations, these figures were 6.7%, 8.0%, and 7.8%, respectively. Whereas, the rate of decompensation events declined in recent years for HBV, and more recently for HCV, it continued rising up for HDV. Likewise, liver cancer rates recently plateaued for HBV and HCV, but kept growing for HDV.

Conclusion

The rate of hepatic decompensation events and liver cancer has declined and/or plateaued in recent years for patients hospitalized with HBV and HCV infections, following the widespread use of oral antiviral therapies for these viruses. In contrast, the rate of decompensated cirrhotic events and HCC has kept rising up for patients with hepatitis delta, for which effective antiviral treatment does not exist yet.

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Funding

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Author information

Authors and Affiliations

  1. Internal Medicine Department, General University Hospital of Alicante-ISABIAL and Miguel Hernández University of Elche, Alicante, Spain

    José-Manuel Ramos-Rincon & Héctor Pinargote-Celorio

  2. Laboratory of Internal Medicine, Puerta de Hierro Research Institute and University Hospital, Majadahonda, Madrid, Spain

    Carmen de Mendoza

  3. Gastroenterology Department, Gregorio Marañón University Hospital, Madrid, Spain

    Clara Ramos-Belinchón

  4. Regional Public Health Laboratory, Hospital Isabel Zendal, Madrid, Spain

    Pablo Barreiro

  5. UNIR Health Sciences School and Medical Center, Calle Almansa 101, 28040, Madrid, Spain

    Ana Treviño, Octavio Corral & Vicente Soriano

Authors
  1. José-Manuel Ramos-Rincon
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  2. Héctor Pinargote-Celorio
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  3. Carmen de Mendoza
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  4. Clara Ramos-Belinchón
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  5. Pablo Barreiro
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  6. Ana Treviño
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  7. Octavio Corral
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  8. Vicente Soriano
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Contributions

JMRR and VS designed the study. JMRR, HPC and CRB cleaned the database. JMRR, HPC, and CRB did the statistical analyses. CdM, PB, AT, and OC contributed with comments and revised the data. VS and JMRR wrote the first draft of the manuscript. All authors revised and contributed to the final submission.

Corresponding author

Correspondence to Vicente Soriano.

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Conflict of interest

José‑Manuel Ramos‑Rincon, Héctor Pinargote‑Celorio, Carmen de Mendoza, Clara Ramos‑Belinchón, Pablo Barreiro, Ana Treviño, Octavio Corral and Vicente Soriano acknowledged no conflicts of interest with this work.

Ethical approval

The study protocol was approved by the Clinical Research Ethics Committee of the Alicante General University Hospital (Alicante, Spain) (ref. CEIm: PI2021-119). The procedures described here were carried out in accordance with the ethical standards described in the Revised Declaration of Helsinki in 2013.

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Ramos-Rincon, JM., Pinargote-Celorio, H., de Mendoza, C. et al. Liver cancer and hepatic decompensation events in patients hospitalized with viral hepatitis in Spain. Hepatol Int 16, 1161–1169 (2022). https://doi.org/10.1007/s12072-022-10365-0

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  • DOI: https://doi.org/10.1007/s12072-022-10365-0

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