A nationwide population based prospective study of cirrhosis in Iceland

Abstract Background The incidence of cirrhosis in Iceland has been the lowest in the world with only 3 cases per 100 000 inhabitants. Alcohol consumption has almost doubled in Iceland from 1980 to 2016. Obesity has also risen and hepatitis C began spreading late in Iceland. The aim of this study was to evaluate the effects of these risk factors on the incidence and etiology of cirrhosis in Iceland. Materials and methods The study included all patients diagnosed with cirrhosis for the first time 2010-2015. Diagnosis was based on liver histology or two of four criteria: cirrhosis on imaging, ascites, varices and/or elevated INR. Results Overall 157 patients were diagnosed, 105 (67%) males, mean age 61 years. The overall incidence was 9.7 cases per 100.000 inhabitants annually. Alcohol was the only underlying cause in 48/157(31%), non-alcoholic fatty liver disease (NAFLD) in 34/157(22%), alcohol and hepatitis C together in 23/157(15%) were the most common causes. Only 6% of patients had an unknown cause of cirrhosis. Upon diagnosis, the median MELD score was 11 (IQR 8-15), 53% were of Child Pugh class A whereas 61(39%) had ascites, 11% encephalopathy and 8% variceal bleeding. In all 25% of deaths were from HCC and 25% from liver failure. Conclusion A major increase in incidence of cirrhosis has occurred in Iceland associated with increase in alcohol consumption, obesity and hepatitis C. In a high proportion NAFLD was the etiology and very few had unknown cause of cirrhosis. The highest death rate was from HCC. Lay summary In a nationwide population-based study from Iceland, including all patients diagnosed with cirrhosis of the liver over a period of 5 years, we found the incidence of new cases had increased threefold compared to a previous study 20 years ago. The increase is due to increased alcohol consumption, an epidemic of diabetes and obesity as well as infection with the hepatitis C virus. Furthermore, we found that with thorough investigations, a specific cause for cirrhosis could be found in 94% of patients. Patients with cirrhosis frequently die of liver cancer and other complications related to their liver disease.