Liver disease-related admissions in Portugal: clinical and demographic pattern

Objective To assess the burden of liver disease in Portugal. Methods Cross-sectional study conducted in 2001 among 773 187 patients, corresponding to 922 611 hospital admissions. Liver disease was defined by International Classification of Diseases (9th edition) codes 570-573. The cost of hospitalization was computed using the groups of homogeneous diagnosis defined by the Portuguese Ministry of Health. Results In 2001 there were 12 371 patients admitted for liver-related disease, for a total of 16 607 hospital admissions, corresponding to 1.6% and 1.8% of all patients and hospital admissions, respectively. The mean age of the subjects was 57+/-16 years, with 8870 (72%) men and 3501 (28%) women. There were 2181 in-hospital deaths, corresponding to 17.6% of the patients admitted. Alcohol-related liver disease (ALD) represented 63% of hospitalizations, and non alcohol-related liver disease (NALD) represented 37%. However, among men there were 69% ALD, while in women this percentage was only 46% (P<0.001). The median length of stay (interquartile range) for each admission was 8 (11) days in ALD and 8 (13) days in NALD, respectively. Complications were reported in 7446 admissions: upper gastrointestinal bleeding, 3436 (46.1%); ascites, 3425 (46.0%); encephalopathy, 2245 (30.2%); jaundice, 122 (11.6%). The cost of hospital admissions for liver disease was C59.4 million, corresponding to 2.4% of all hospital health care expenses. Conclusion Although there are strong limitations depending mostly on the inadequacy of International Classification of Diseases (9th edition) regarding liver disease, present data indicate that this condition is still mainly associated with alcohol, representing an important burden in what concerns either hospitalization time or economic costs.