Etiological Spectrum of Cirrhosis in India: A Systematic Review and Meta-analysis

Shekhar Swaroop; Manas Vaishnav; Umang Arora; Sagnik Biswas; Arnav Aggarwal; Soumya Sarkar; Puneet Khanna; Anshuman Elhence; Ramesh Kumar; Amit Goel; Shalimar

doi:10.1016/j.jceh.2023.10.002

Etiological Spectrum of Cirrhosis in India: A Systematic Review and Meta-analysis

J Clin Exp Hepatol. 2024 Mar-Apr;14(2):101291. doi: 10.1016/j.jceh.2023.10.002. Epub 2023 Oct 9.

Authors

Affiliations

¹ Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India.
² Department of Anaesthesia, All India Institute of Medical Sciences, Kalyani, West Bengal, India.
³ Department of Anaesthesia, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
⁴ Department of Gastroenterology, All India Institute of Medical Sciences, Patna, Bihar, India.
⁵ Department of Hepatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.

PMID: 38544766
PMCID: PMC10964076 (available on 2025-03-01)
DOI: 10.1016/j.jceh.2023.10.002

Abstract

Background: Cirrhosis is a significant cause of morbidity and mortality globally and in India. This systematic review and meta-analysis aimed to ascertain the etiological spectrum and changing trends of cirrhosis in India.

Methods: We searched electronic databases, including Pubmed/Medline, Scopus, and Embase. We included original studies that reported the etiology of cirrhosis in the Indian population.

Results: We included 158 studies (adults: 147, children: 11). The overall pooled estimate of alcohol as a cause of cirrhosis in adults was 43.2% (95% confidence interval (CI) 39.8-46.6%; I² = 97.8%), followed by nonalcoholic fatty liver disease (NAFLD)/cryptogenic in 14.4%, 95% CI (11.7-17.3%; I² = 98.4%), hepatitis B virus (HBV) in 11.5%, 95% CI (9.8-13.3%; I² = 96.6%), and hepatitis C virus (HCV) in 6.2%, 95% CI (4.8-7.8%; I² = 97.2%) of the included patients. The most common cause of cirrhosis in all zones was alcohol-related. Comparison of etiologies over time revealed a reduction in the viral hepatitis-related and an increase in the proportion of alcohol-related and NAFLD/cryptogenic-related cirrhosis. The overall pooled estimates of various etiologies in children were: HBV in 10.7%, 95% CI (4.6-18.7%; I² = 91.0%), NAFLD/Cryptogenic in 22.3%, 95% CI (9.0-39.2%; I² = 96.7%), and HCV in 2.0%, 95% CI (0.0-8.5%; I² = 94.6%).

Conclusions: Alcohol is the most common etiology of cirrhosis in adults in India. The proportions of alcohol and NAFLD-related cirrhosis are increasing, and those of viral hepatitis-related cirrhosis are reducing. The results of our meta-analysis will help formulate health policies and the allocation of resources.

Keywords: alcohol; chronic liver disease; hepatitis B; hepatitis C.