Administrative coding for alpha-1 antitrypsin deficiency including the pi*ZZ phenotype is accurate in Sweden.

Background: We aimed to validate the International Classification of Diseases (ICD)-10 codes for alpha-1 antitrypsin deficiency (AATD) (E880A = asymptomatic AATD; E880B = symptomatic AATD) in a large hospital reporting to the Swedish National Patient Register and to ascertain their relation to the protease inhibitor (Pi)*ZZ-phenotype.

Methods: We randomly selected 150 adults and 50 children who visited Karolinska University Hospital (Stockholm, Sweden) between 2014 and 2024 with coding for E880A or E880B (1:1). Positive predictive values (PPVs) of AATD ICD-10 codes were calculated for correctly assigned codes and the Pi*ZZ-phenotype using medical charts as gold standard.

Phosphatidylethanol levels distinguish steatotic liver disease subgroups and are associated with risk of major liver outcomes.

Background & Aims: Phosphatidylethanol (PEth) is an ethanol metabolite used as a specific biomarker for recent alcohol consumption. We aimed to determine the proportion of patients with or at risk for metabolic dysfunction-associated steatotic liver disease (MASLD) who had PEth levels indicative of harmful alcohol consumption, and to assess associations between PEth levels and the risk of major adverse liver outcomes (MALOs).

Methods: We conducted a cohort study involving persons tested for PEth in Stockholm, Sweden between 2012 and 2020 (N = 46,406), including patients with various steatotic liver disease (SLD) subtypes and individuals without SLD.

Cause-specific mortality in 13,099 patients with metabolic dysfunction-associated steatotic liver disease in Sweden.

Background & Aims: Data on cause-specific mortality in metabolic dysfunction-associated steatotic liver disease (MASLD) are limited. We aimed to determine the rate and risk of death from different causes in patients with MASLD compared to the general population in Sweden.

Methods: In this population-based cohort study, we identified individuals with an ICD-10 code for MASLD in inpatient or specialized outpatient care using Swedish healthcare registers from 2002-2020 (n = 13,099) and matched them with up to 10 controls (median 9) from the general population for age, sex, municipality, and calendar year (n = 118,884).

Risk of hepatic decompensation or HCC is similar in patients with ALD- and MASLD-cirrhosis: A population-based cohort study.

Background: It is unclear if the risk of hepatic decompensation or hepatocellular carcinoma (HCC) differs between patients with compensated alcohol-related liver disease (ALD)- and metabolic dysfunction-associated steatotic liver disease (MASLD)-cirrhosis. We investigated the risk to develop hepatic decompensation or HCC based on ALD or MASLD as the underlying etiology of cirrhosis.

Methods: All patients with a new diagnosis in hospital-based outpatient care of ALD- or MASLD-cirrhosis in Sweden between 2002 and 2020 were identified using national registers.

Timely Follow-Up After a First Diagnosis of Cirrhosis is Associated With Reduced Mortality but No Impact on Rehospitalisations: A Population-Based Cohort of 8852 Patients.

Background And Aims: Timely transition of care amongst patients with a first diagnosis of cirrhosis in a hospital to an outpatient visit is important. We evaluated rates of outpatient follow-up after a first diagnosis of cirrhosis during an inpatient setting, and its association with subsequent rates of rehospitalisation and mortality.

Methods: We conducted a population-based cohort study identifying all hospitalised patients in Sweden diagnosed with cirrhosis between 2002 and 2020 from the Swedish National Patient Register.

Lower Incidence of HCC and Other Major Adverse Liver Outcomes in People Living With HIV and Chronic Liver Disease.

Background And Aims: People living with human immunodeficiency virus (HIV) (PLWH) show a high incidence of chronic liver disease (CLD). However, whether HIV is associated with major adverse liver outcomes (MALO) in patients with underlying CLD remains to be determined.

Methods: In this population-based cohort study, data were retrieved from the Swedish National Patient Register to identify PLWH and CLD (n = 2375) or CLD without HIV (n = 144,346) between 1997 and 2020.

Socioeconomic factors associated with the presence of and outcomes in metabolic dysfunction-associated steatotic liver disease.

Background And Aims: The association between socioeconomic factors and disease severity is not well studied in people living with metabolic dysfunction-associated steatotic liver disease (MASLD). We thus examined if socioeconomic factors influence the presence of, or risk for future, major adverse liver outcomes (MALOs) in people living with MASLD.

Methods: We conducted a register-based cohort study that included all individuals with a MASLD diagnosis between 1987 and 2020 in Sweden.

Persons with metabolic dysfunction-associated steatotic liver disease are at increased risk of severe depression.

Background And Aim: Few population-based studies have investigated the association between metabolic dysfunction-associated steatotic liver disease (MASLD) and depression. Additionally, it remains unclear if depression affects progression to major adverse liver outcomes (MALO) in MASLD.

Methods: All patients in Sweden with newly diagnosed MASLD between 2006 and 2020 were identified from the National Patient Register.

Abbreviated Versus Standard Dual Antiplatelet Therapy Times After Percutaneous Coronary Intervention in Patients With High Bleeding Risk With Acute Coronary Syndrome: Insights From the SWEDEHEART Registry.

Background: Dual antiplatelet therapy (DAPT) reduces ischemic events but increases bleeding risk, especially in patients with high bleeding risk (HBR). This study aimed to compare outcomes of abbreviated versus standard DAPT strategies in patients with HBR with acute coronary syndrome undergoing percutaneous coronary intervention.

Methods And Results: Patients from the SWEDEHEART (Swedish Web-system for Enhancement and Development of Evidence-Based Bare in Heart Disease Evaluated According to Recommended Therapies) registry with at least 1 HBR criterion who underwent percutaneous coronary intervention for acute coronary syndrome were identified and included.

Statin initiation after myocardial infarction in patients with alcohol-related liver disease: A nationwide population-based study.

Background And Aims: Secondary prevention with statins improves clinical outcomes after myocardial infarction (MI). We aimed to compare odds of statin initiation after MI in patients with co-existing alcohol-related liver disease (ALD) to the general population, and the association between statin initiation and mortality in the patients with ALD.

Methods: All statin-naïve patients with ALD and a first-time MI between 2006 and 2020 were identified from Swedish healthcare registers and matched for age, sex, and year of MI with up to ten ALD-free general population controls with a first-time MI.

Liver stiffness predicts progression to liver-related events in patients with chronic liver disease - A cohort study of 14 414 patients.

Background & Aims: Liver stiffness measurement (LSM) by vibration-controlled transient elastography (VCTE) is a non-invasive diagnostic biomarker of liver fibrosis. It is uncertain if LSM can predict risk for future liver-related outcomes in large, heterogenous populations.

Methods: This Swedish multi-centre cohort study included patients (n = 14 414) from 16 sites who underwent LSM by VCTE between 2008 and 2020.

Glucagon-like peptide-1 receptor agonists and risk of major adverse liver outcomes in patients with chronic liver disease and type 2 diabetes.

Objective: Phase II trials suggest glucagon-like peptide-1 receptor (GLP1) agonists resolve metabolic dysfunction-associated steatohepatitis but do not affect fibrosis regression. We aimed to determine the long-term causal effect of GLP1 agonists on the risk of major adverse liver outcomes (MALO) in patients with any chronic liver disease and type 2 diabetes.

Design: We used observational data from Swedish healthcare registers 2010-2020 to emulate a target trial of GLP1 agonists in eligible patients with chronic liver disease and type 2 diabetes.

Misclassified Alcohol-related Liver Disease is Common in Presumed Metabolic Dysfunction-associated Steatotic Liver Disease and Highly Increases Risk for Future Cirrhosis.

Background & Aims: Alcohol overconsumption is a risk factor for disease progression in patients with presumed metabolic dysfunction-associated steatotic liver disease (MASLD). How commonly this occurs and how it affects progression to major adverse liver outcomes (MALOs) is not well known.

Methods: We did a register-based cohort study, including all patients with a diagnosis of MASLD in Sweden between 1987 and 2020.

Risk of injuries before and after a diagnosis of cirrhosis: A population-based cohort study.

Background: Cirrhosis is often asymptomatic prior to decompensation. Still, cognitive impairment and sarcopenia may be present before decompensation, possibly increasing the risk of injuries. We estimated the risk of injuries during the period shortly before and after cirrhosis diagnosis.

Time trends in mortality and life expectancy in 22,658 patients hospitalized with alcohol-associated cirrhosis: A nationwide cohort study.

Background: The management of alcohol-associated cirrhosis has improved in the last decades, but whether the prognosis has changed over time is uncertain. We aimed to assess time trends in mortality and life expectancy in patients hospitalized with alcohol-associated cirrhosis.

Methods: In this population-based cohort study, we used the Swedish national population and health registers to identify all patients with a first episode of in-hospital alcohol-associated cirrhosis from 1969 to 2019 (n = 22,658).

Porphyrin precursors and risk of primary liver cancer in acute intermittent porphyria: A case-control study of 188 patients.

Acute intermittent porphyria (AIP) is a rare hereditary metabolic disease characterized by acute attacks and accumulation of the porphyrin precursors 5-aminolevulinic acid (ALA) and porphobilinogen (PBG). Patients with AIP have a high risk of primary liver cancer (PLC). We aimed to assess the association between porphyrin precursor excretion and the risk for PLC in patients with AIP.

Four-fold increased mortality rate in patients with Wilson's disease: A population-based cohort study of 151 patients.

Background And Aims: Few studies have investigated mortality rates in patients with Wilson's disease and compared these to the general population. Here, we examined several clinical outcomes (including cardiovascular, psychiatric, neurologic conditions) in a population-based study of patients with Wilson's disease.

Method: We used nationwide registers to identify all patients with a first diagnosis of Wilson's disease between 2002 and 2020 in Sweden.

Risk of infections in non-alcoholic fatty liver disease: A nationwide population-based cohort study.

Background And Aims: Previous literature suggests an association between non-alcoholic fatty liver disease (NAFLD) and infections. We aimed to determine the rate and risk of severe infections in NAFLD compared to the general population.

Methods: In this population-based cohort study, we used national registers to identify all patients with a hospital-based diagnosis of NAFLD in Sweden 1987-2020 (n = 14 869).

Risk of Cancer and Subsequent Mortality in Primary Biliary Cholangitis: A Population-based Cohort Study of 3052 Patients.

Background And Aims: Primary biliary cholangitis (PBC) is a rare cholestatic liver disease. Incident cancer is a concern. Previous studies have described an increase in hepatocellular carcinoma (HCC), but the risk of nonhepatic cancer and cancer risk across subgroups is largely unknown.

Risk of Severe Infection in Patients With Biopsy-proven Nonalcoholic Fatty Liver Disease - A Population-based Cohort Study.

Background & Aims: It has been suggested that patients with nonalcoholic fatty liver disease (NAFLD) might be at increased risk of severe infections, but large-scale data from cohorts with biopsy-proven NAFLD are lacking.

Methods: Population-based cohort study including all Swedish adults with histologically confirmed NAFLD (n = 12,133) from 1969 to 2017. NAFLD was defined as simple steatosis (n = 8232), nonfibrotic steatohepatitis (n = 1378), noncirrhotic fibrosis (n = 1845), and cirrhosis (n = 678).

Secondary Prevention of Esophageal Variceal Bleeding Is Often Imperfect: A National, Population-Based Cohort Study of 3592 Patients.

Background And Aims: Secondary prevention of esophageal variceal bleeding is important to improve prognosis, but uptake of guidelines is unknown in a real-world setting. Here, we determined the proportion of patients receiving appropriate nonselective beta-blocker treatment and repeat upper endoscopy after a first episode of esophageal variceal bleeding within a reasonable time frame.

Methods: Population-based registers were used to identify all patients with a first episode of esophageal variceal bleeding in Sweden from 2006 to 2020.

Administrative coding for non-alcoholic fatty liver disease is accurate in Swedish patients.

Epidemiological studies of non-alcoholic fatty liver disease (NAFLD) frequently use the International Classification of Disease (ICD) codes to identify patients. The validity of such ICD codes in a Swedish setting is unknown. Here, we aimed to validate the administrative code for NAFLD in Sweden.