{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T23:51:58Z","timestamp":1787615518494,"version":"build-2736575974"},"reference-count":27,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2023,11,22]],"date-time":"2023-11-22T00:00:00Z","timestamp":1700611200000},"content-version":"unspecified","delay-in-days":21,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Northern Health Science Alliance","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"DOI":"10.13039\/501100000276","name":"UK Department of Health","doi-asserted-by":"crossref","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100000276","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,11,2]]},"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To examine time trends in patient characteristics, care processes and case fatality of first emergency admission for alcohol-related liver disease (ARLD) in England.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>National population-based, retrospective observational cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Clinical Practice Research Datalink population of England, 2008\/2009 to 2017\/2018. First emergency admissions were identified using the Liverpool ARLD algorithm. We applied survival analyses and binary logistic regression to study prognostic trends.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>Patient characteristics; \u2018recent\u2019 General Practitioner (GP) consultations and hospital admissions (preceding year); higher level care; deaths in-hospital (including certified cause) and within 365 days. Covariates were age, sex, deprivation status, coding pattern, ARLD stage, non-liver comorbidity, coding for ascites and varices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>17\u2009575 first admissions (mean age: 53 years; 33% women; 32% from most deprived quintile). Almost half had codes suggesting advanced liver disease. In year before admission, only 47% of GP consulters had alcohol-related problems recorded; alcohol-specific diagnostic codes were absent in 24% of recent admission records. Overall, case fatality rate was 15% in-hospital and 34% at 1\u2009year. Case-mix-adjusted odds of in-hospital death reduced by 6% per year (adjusted OR (aOR): 0.94; 95%\u2009CI: 0.93 to 0.96) and 4% per year at 365 days (aOR: 0.96; 95%\u2009CI: 0.95 to 0.97). Exploratory analyses suggested the possibility of regional inequalities in outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite improving prognosis of first admissions, we found missed opportunities for earlier recognition and intervention in primary and secondary care. In 2017\/2018, one in seven were still dying during index admission, rising to one-third within a year. Nationwide efforts are needed to promote earlier detection and intervention, and to minimise avoidable mortality after first emergency presentation. Regional variation requires further investigation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-076955","type":"journal-article","created":{"date-parts":[[2023,11,22]],"date-time":"2023-11-22T12:36:06Z","timestamp":1700656566000},"page":"e076955","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Outcomes of first emergency admissions for alcohol-related liver disease in England over a 10-year period: retrospective observational cohort study using linked electronic databases"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1825-3239","authenticated-orcid":false,"given":"Keith","family":"Bodger","sequence":"first","affiliation":[{"name":"Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK"},{"name":"Gastroenterology Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Mair","sequence":"additional","affiliation":[{"name":"Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peit\u00e0","family":"Schofield","sequence":"additional","affiliation":[{"name":"Department of Public Health & Policy, University of Liverpool, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Silberberg","sequence":"additional","affiliation":[{"name":"Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steve","family":"Hood","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate M","family":"Fleming","sequence":"additional","affiliation":[{"name":"Data & Analytics Transformation Directorate, NHS England, Redditch, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,11,22]]},"reference":[{"key":"2025120523384558000_13.11.e076955.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)32866-0"},{"key":"2025120523384558000_13.11.e076955.2","unstructured":"National confidential enquiry into patient outcome and death . Measuring the units: a review of patients who died with alcohol-related liver disease. 2013. Available: https:\/\/www.ncepod.org.uk\/2013report1\/downloads\/MeasuringTheUnits_FullReport.pdf [Accessed 01 Oct 2019]."},{"key":"2025120523384558000_13.11.e076955.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)62152-2"},{"key":"2025120523384558000_13.11.e076955.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61838-9"},{"key":"2025120523384558000_13.11.e076955.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00680-7"},{"key":"2025120523384558000_13.11.e076955.6","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.1111\/apt.13806","article-title":"Implementation of a \u2018care bundle\u2019 improves the management of patients admitted to hospital with decompensated cirrhosis","volume":"44","author":"Dyson","year":"2016","journal-title":"Aliment Pharmacol Ther"},{"key":"2025120523384558000_13.11.e076955.7","doi-asserted-by":"publisher","DOI":"10.1136\/flgastro-2014-100491"},{"key":"2025120523384558000_13.11.e076955.8","doi-asserted-by":"crossref","first-page":"291","DOI":"10.4997\/jrcpe.2018.401","article-title":"Tackling the epidemic: the NCEPOD report on alcohol-related liver disease and the lancet commission on liver disease","volume":"48","author":"Kiat","year":"2018","journal-title":"J R Coll Physicians Edinb"},{"key":"2025120523384558000_13.11.e076955.9","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1053\/j.gastro.2012.03.038","article-title":"The quality of care provided to patients with cirrhosis and ascites in the department of veterans affairs","volume":"143","author":"Kanwal","year":"2012","journal-title":"Gastroenterology"},{"key":"2025120523384558000_13.11.e076955.10","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)32908-3"},{"key":"2025120523384558000_13.11.e076955.11","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1111\/apt.15781","article-title":"Reducing variation in hospital mortality for alcohol-related liver disease in North West England","volume":"52","author":"Kallis","year":"2020","journal-title":"Aliment Pharmacol Ther"},{"key":"2025120523384558000_13.11.e076955.12","unstructured":"NHS Digital . 1.8 emergency admissions for alcohol related liver disease. 2022. Available: https:\/\/digital.nhs.uk\/data-and-information\/publications\/statistical\/ccg-outcomes-indicator-set\/june-2020\/domain-1-preventing-people-from-dying-prematurely-ccg\/1-8-emergency-admissions-for-alcohol-related-liver-disease"},{"key":"2025120523384558000_13.11.e076955.13","doi-asserted-by":"crossref","first-page":"2053","DOI":"10.1016\/S0140-6736(16)32234-6","article-title":"New metrics for the lancet standing commission on liver disease in the UK","volume":"389","author":"Williams","year":"2017","journal-title":"Lancet"},{"key":"2025120523384558000_13.11.e076955.14","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.i124","article-title":"Decompensated alcohol related liver disease: acute management","volume":"352","author":"McPherson","year":"2016","journal-title":"BMJ"},{"key":"2025120523384558000_13.11.e076955.15","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1111\/apt.17307","article-title":"The liverpool alcohol-related liver disease algorithm identifies twice as many emergency admissions compared to standard methods when applied to hospital episode statistics for England","volume":"57","author":"Dhanda","year":"2023","journal-title":"Aliment Pharmacol Ther"},{"key":"2025120523384558000_13.11.e076955.16","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1111\/apt.17335","article-title":"Editorial: the burden of alcohol-related liver disease emergency admissions in England may be twice as high as previously thought","volume":"57","author":"King","year":"2023","journal-title":"Aliment Pharmacol Ther"},{"key":"2025120523384558000_13.11.e076955.17","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyz034"},{"key":"2025120523384558000_13.11.e076955.18","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1111\/apt.15315","article-title":"Nationwide improvement in outcomes of emergency admission for ulcerative colitis in England, 2005-2013","volume":"50","author":"Shawihdi","year":"2019","journal-title":"Aliment Pharmacol Ther"},{"key":"2025120523384558000_13.11.e076955.19","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"2025120523384558000_13.11.e076955.20","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/S2468-1253(17)30082-1","article-title":"Missed opportunities for intervention in alcohol-related liver disease in the UK","volume":"2","author":"Burton","year":"2017","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2025120523384558000_13.11.e076955.21","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2016-013752","article-title":"Liver cirrhosis in England-an observational study: are we measuring its burden occurrence correctly","volume":"7","author":"Ratib","year":"2017","journal-title":"BMJ Open"},{"key":"2025120523384558000_13.11.e076955.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2019.01.026"},{"key":"2025120523384558000_13.11.e076955.23","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1097\/CCM.0000000000002961","article-title":"Incidence and outcomes for patients with cirrhosis admitted to the United Kingdom critical care units","volume":"46","author":"McPhail","year":"2018","journal-title":"Crit Care Med"},{"key":"2025120523384558000_13.11.e076955.24","unstructured":"Liver Atlas of variation. Available: http:\/\/tools.england.nhs.uk\/images\/LiverAtlas17\/atlas.html [Accessed 23 Sep 2023]."},{"key":"2025120523384558000_13.11.e076955.25","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/S2468-1253(19)30349-8","article-title":"The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017: a systematic analysis for the global burden of disease study 2017","volume":"5","year":"2020","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2025120523384558000_13.11.e076955.26","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1111\/apt.15232","article-title":"Early and late mortality following unscheduled admissions for severe liver disease across England and Wales","volume":"49","author":"Roberts","year":"2019","journal-title":"Aliment Pharmacol Ther"},{"key":"2025120523384558000_13.11.e076955.27","unstructured":"National Confidential Enquiry into Patient Outcome and Death . Remeasuring the units: an update on the organisation of alcohol-related liver disease services. 2022. Available: https:\/\/www.ncepod.org.uk\/pdf\/current\/Remeasuring%20the%20Units_full%20report.pdf"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2023-076955","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T07:38:56Z","timestamp":1765006736000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2023-076955"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11]]},"references-count":27,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,11,22]]},"published-print":{"date-parts":[[2023,11]]}},"alternative-id":["10.1136\/bmjopen-2023-076955"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2023-076955","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11]]}}}