Standards of liver cirrhosis care in Central Australia

Table 1 Descriptive statistics for all data and all variables in the study

Total number of patients	193
Age at diagnosis, years–mean ± SD	50.7 (11.9)
Gender
Female	82 (42.5%)
Male	111 (57.5%)
Aboriginal	154 (79.8%)
Residence
Alice Springs	58 (30.1%)
Alice Springs township	31 (16.1%)
Rural	104 (53.9%)
Risk factors
IVDU	15 (7.9%)
Hazardous alcohol intake	137 (71.4%)
Obesity	63 (35.6%)
Child-Pugh score
A	94 (50%)
B	71 (37.8%)
C	23 (12.2%)
MELD score–median (IQR)	10 (8, 18)
Decompensating event triggering admission	58 (30.4%)
Aetiology
Alcohol	96 (49.7%)
Hepatitis B	22 (11.4%)
NAFLD	11 (5.7%)
Hepatitis C	9 (4.7%)
Cardiac cirrhosis	6 (3.1%)
Cryptogenic	6 (3.1%)
Autoimmune hepatitis	2 (1%)
Biliary diseases	2 (1%)
NAFLD + Alcohol	5 (2.6%)
Hepatitis C + Alcohol	11 (5.7%)
Hepatitis B + Alcohol	18 (9.3%)
Cardiac cirrhosis + NAFLD	3 (1.6%)
Hepatitis B + NAFLD	2 (1.0%)
Participation in variceal surveillance	75 (41.9%)
Participation in HCC surveillance	32 (20.3%)
Development of HCC during study period	29 (15.0%)
Review in specialist clinic	95 (49.5%)
Referral for liver transplantation	12 (6.4%)

NAFLD: Non-Alcoholic fatty liver disease; HCC: Hepatocellular carcinoma; MELD: Model for End-stage Liver Disease; IVDU: Intravenous drug use.

Table 2 Comparison of aboriginal vs non-aboriginal patients

	Aboriginal	Non-aboriginal	P value
Total number	154 (79.8%)	39 (20.2%)
Age at diagnosis–mean ± SD	48.4 (11.1)	59.9 (10.9)	< 0.001
Gender–Female	76 (49.4%)	6 (15.4%)	< 0.001
Residence			< 0.001
Alice Springs	24 (15.6%)	34 (87.2%)
Alice Springs camp	31 (20.1%)	0
Rural	99 (64.3%)	5 (12.8%)
Risk factors
IVDU	2 (1.3%)	13 (33.3%)	< 0.001
Hazardous alcohol intake	111 (72.6%)	26 (66.7%)	0.468
Obesity	48 (34.5%)	15 (38.4%)	0.573
Child-Pugh score			0.091
A	69 (46.3%)	25 (64.1%)
B	62 (41.6%)	9 (23.1%)
C	18 (12.1%)	5 (12.8%)
MELD score–median (IQR)	11 (8, 20)	10 (8, 12)	0.026
Decompensating event triggering admission	45 (29.4%)	13 (34.2%)	0.565
Aetiology			< 0.001
Alcohol	86 (55.8%)	10 (25.6%)
Hepatitis B	20 (13.0%)	2 (5.1%)
NAFLD	12 (7.8%)	2 (5.1%)
Hepatitis C	1 (0.7%)	8 (20.5%)
Cardiac cirrhosis	4 (2.6%)	2 (5.1%)
Cryptogenic	4 (2.6%)	2 (5.1%)
Autoimmune hepatitis	1 (0.7%)	1 (2.6%)
Biliary diseases	0	2 (5.1%)
Hepatitis B + Alcohol	18 (11.7%)	0
NAFLD + Alcohol	5 (3.3%)	0
Hepatitis C + Alcohol	1 (0.7%)	10 (25.6%)
Hepatitis B + NAFLD	2 (1.3%)	0
Variceal surveillance	24 (17.8%)	11 (34.4%)	0.002
HCC surveillance	21 (16.7%)	11 (34.4%)	0.038
Development of HCC	21 (13.6%)	8 (20.5%)	0.283
Review in specialist clinic	63 (41.2%)	32 (84.1%)	< 0.001
Referral for liver transplantation	5 (3.3%)	7 (18.9%)	< 0.001

NAFLD: Non-Alcoholic fatty liver disease; HCC: Hepatocellular carcinoma; MELD: Model for End-stage Liver Disease; IVDU: Intravenous drug use.

Table 3 Unadjusted and adjusted binary logistic models of hepatocellular carcinoma surveillance versus Aboriginal status

Risk factor	Surveillance participation		Comparison	Odds ratio (95%CI)	P value	Odds ratio (95%CI)	P value
	Yes	No		Univariate		Multivariable
Aboriginal status-Yes	18	95	Yes vs No	0.31 (0.13, 0.77)	0.011	0.29 (0.10, 0.87)	0.028
Age-mean ± SD	51.7 (10.9)	49.4 (10.8)		1.02 (0.98, 1.06)	0.308	1.00 (0.95, 1.04)	0.866
Gender–Male	18	64	Female vs Male	0.80 (0.35, 1.84)	0.398	1.10 (0.45, 2.71)	0.838
Child-Pugh score					0.930		0.950
A	18	65	A vs B	1.18 (0.51, 2.74)	0.694	0.97 (0.40, 2.34)	0.942
B	11	47
Residence					0.026
Alice Springs	14	27	AS vs ASC	11.41 (1.39, 93.66)	0.023
Alice Springs camps	1	22	AS vs R	2.37 (1.00, 5.64)	0.05
Rural	14	64	AST vs R	0.21 (0.03, 1.67)	0.14
See specialist liver clinic–Yes	26	52	Yes vs No	10.17 (2.91, 35.52)	< 0.001

AS: Alice springs; ASC: Alice springs camps; AST: Aspartate aminotransferase.

Table 4 Unadjusted and adjusted binary logistic models of Variceal surveillance

Risk factor	Surveillance participation		Comparison	Odds ratio (95%CI)	P value	Odds ratio (95%CI)	P value
	Yes	No		Univariate		Multivariable
Aboriginal Status-Yes	51	90	Yes vs No	0.31 (0.14, 0.65)	0.002	0.29 (0.12, 0.69)	0.005
Age-mean ± SD	51.9 (11.6)	49.2 (11.2)		1.02 (0.99, 1.04)	0.116	1.01 (0.98, 1.04)	0.621
Gender–Male	43	59	Female vs Male	1.00 (0.55, 1.82)	0.995	1.36 (0.70, 2.63)	0.358
Child-Pugh score					0.930		0.950
A	39	51	A vs B	1.13 (0.60, 2.15)	0.703	0.90 (0.45, 1.76)	0.750
B	27	40	A vs C	1.05 (0.39, 2.86)	0.922	0.96 (0.34, 2.71)	0.941
C	8	11	B vs C	0.93 (0.33, 2.61)	0.888	1.07 (0.37, 3.13)	0.900
Residence					0.002
Alice Springs	33	20	AS vs ASC	4.03 (1.55, 10.47)	0.004
Alice Springs camps	9	22	AS vs R	3.05 (1.52, 6.13)	0.002
Rural	33	61	AST vs R	0.76 (0.31, 1.83)	0.535
See specialist liver clinic–Yes	54	39	Yes vs No	4.22 (2.22, 8.02)	< 0.001

AS: Alice Springs; ASC: Alice Springs camps; AST: Aspartate aminotransferase.