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Liver cirrhosis in selected autoimmune diseases: a nationwide cohort study in Taiwan

  • Original Article - Epidemiology of RMD
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Abstract

The association between autoimmune diseases and liver cirrhosis has rarely been explored in Asian populations, an endemic area of viral hepatitis. The aim of this study was to investigate the comparative risk of liver cirrhosis among a group of selective autoimmune diseases in Taiwanese patients and to identify groups of high risk. This retrospective study was a nationwide, population-based study and used Taiwan’s National Health Insurance Research Database. A total of 29,856 patients with definite diagnosis of selected autoimmune diseases (Registry of Taiwan Catastrophic Illness Database, ACR classification) at the starting time point of January 1, 2005, were enrolled in this study. After tracked for a 5-year period, the endpoints were diagnosis of liver cirrhosis (in accordance with International Classification of Diseases, Ninth Revision, Clinical Modification, ICD-9-CM codes 571). The control group was composed of other patients in the same database and consisted of randomly selected 753,495 sex- and age-matched non-autoimmune disease patients. The Cox proportional hazard regression model was used to calculate the risk of liver cirrhosis after adjusting for certain variables such as comorbidity, living area, and socioeconomic status. Among the patients with selected autoimmune diseases, 1987 liver cirrhosis were observed. Patients with psoriasis had a significantly increased risk of liver cirrhosis (HR 1.87, 95 % CI 1.25–2.81) than control group without psoriasis. The risk of liver cirrhosis was significantly lower in patients with rheumatoid arthritis (HR 0.29, 95 % CI 0.19–0.44). There is a gradient of risk of liver cirrhosis among the autoimmune diseases; the specific risks need to be investigated on the basis of hypotheses. Conventional immunosuppressive drug administration should be carefully implemented by regular monitoring of liver condition in order to avoid causing an adverse effect of chronic liver fibrosis.

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Acknowledgments

This study is based in part on data from the National Health Insurance Research Database provided by the Bureau of National Health Insurance, Department of Health and managed by the National Health Research Institutes (No. 100195). The interpretation and conclusions contained herein do not represent those of the aforementioned institutions.

Author contribution

All the authors revised and approved the contents of the submitted article. C.-H.T. and N.-S.L. conceptualized the idea of the manuscript. C.-C.L. conducted statistical analysis of the data. C.-H.T., N.-S.L., M.-C.L., and C.-C.L. made substantial contributions to the interpretation of data. C.-H.T. wrote the manuscript. All the authors carried out a critical revision of the manuscript for important intellectual content.

Funding

This study was funded in part by the Buddhist Dalin Tzu Chi General Hospital (DTCRD 100(2)-I-12). The organization providing funding resource had no role in the design, analysis of the data, or in the decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Division of Allergy, Immunology and Rheumatology, Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Ming-Sheng Road, Dalin Town, Chiayi, 622, Taiwan, Republic of China

    Chien-Hsueh Tung, Ning-Seng Lai & Ming-Chi Lu

  2. Department of Otolaryngology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan, Republic of China

    Ching-Chih Lee

  3. College of Medicine, Tzu Chi University, Hualian, Taiwan, Republic of China

    Chien-Hsueh Tung, Ning-Seng Lai, Ming-Chi Lu & Ching-Chih Lee

  4. Center for Clinical Epidemiology and Biostatistics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan, Republic of China

    Ching-Chih Lee

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  1. Chien-Hsueh Tung
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  2. Ning-Seng Lai
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Correspondence to Chien-Hsueh Tung.

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The authors disclose no competing interests related to this study.

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Tung, CH., Lai, NS., Lu, MC. et al. Liver cirrhosis in selected autoimmune diseases: a nationwide cohort study in Taiwan. Rheumatol Int 36, 199–205 (2016). https://doi.org/10.1007/s00296-015-3369-z

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  • DOI: https://doi.org/10.1007/s00296-015-3369-z

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