Evaluation of comorbidity in patients with alcoholic cirrhosis of the liver associated with non-alcoholic fatty liver disease


  • N. R. Matkovska Ivano-Frankivsk National Medical University, Ukraine,
  • N. H. Virstiuk Ivano-Frankivsk National Medical University, Ukraine,
  • U. V. Balan Ivano-Frankivsk National Medical University, Head of Clinical and Diagnostic Laboratory of the Regional Clinical Hospital, Ukraine,




alcoholic liver disease, non-alcoholic fatty liver disease, cirrhosis, comorbidity



The aim of the study was to evaluate the concomitant pathology in patients with alcoholic cirrhosis of the liver associated with non-alcoholic fatty liver disease, depending on the compensation of the disease and patient's age.

Material and methods of research. The study included 204 patients. Among them, 78 patients (Group I) had alcoholic liver cirrhosis (ALC) and 126 patients (Group II) had a combination of ALC with non-alcoholic fatty liver disease (NAFLD). Patients were subgrouped according to compensation classes by the Child-Pugh score (A, B, C). To evaluate comorbidity, CirCom, CCI, ECI indices were used.

Results. More than 70 % of patients of group II had concomitant diseases (CD) and cardiovascular complications. They also suffered from pleurisy, pneumonia, spontaneous bacterial peritonitis more frequently. 46 % of patients of groups ІІА+B, who were less than 45 years old, had two CD, which 2.6 times exceeded the number of such persons in group І. More than 80 % of middle-aged patients in group IIA+B had more than 3 CD, which is 1.7 times more than in group І. 70 % of patients of group II at the stage of decompensation of cirrhosis had 5 or more CD. The direct relationship between the age of patients and the number of CD, as well as between the degree of compensation and the amount of CD leads to a more severe course of the disease in people of group II. The significant correlation between the CCI, ECI, CirCom scales and the Child–Pugh degree of the disease severity was detected. The number of concomitant pathologies in patients suffering from liver cirrhosis (LC) significantly increased the risk of death from the causes which are not related to LC (RR: 5.872; 95 % CI: 1.866–18.477). 4-year observation showed that 80.6 % patients of group II have died, which 4 times exceeded the number of those who had ALC.

Conclusions. Most patients of group II had cardiovascular diseases. They had disorders of the respiratory, urinary, endocrine, nervous systems, as well as bacterial complications, more frequently. It is useful to use the CCI, ECI, CirCom scales of comorbidity, and Child-Pugh degree of the disease severity in considering the comorbidity level and severity of the disease. The incidence of CD increases with age and significantly increases the risk of death from causes which are not associated with the complications of the LC.



Schiavo, L., Busetto, L., Cesaretti, M., Zelber-Sagi, S., Deutsch, L., & Iannelli, A. (2018). Nutritional issues in patients with obesity and cirrhosis. World Journal of Gastroenterology, 24(30), 3330-3346. https://doi.org/10.3748/wjg.v24.i30.3330

MOZ Ukrainy, & DU «UISD MOZ Ukrainy». (2018). Shchorichna dopovid pro stan zdorovia naselennia, sanitarno-epidemichnu sytuatsiiu ta rezultaty diialnosti systemy okhorony zdorovia Ukrainy. 2017 rik [The annual report on the health of the population, sanitary and epidemic situation, and the results of the health care system of Ukraine. 2017]. Medinform. [in Ukrainian].

Sharabchiev, Yu. T., Antipov, V. V., & Antipova, S. I. (2014). Komorbidnost' – aktual'naya nauchnaya i nauchno-prakticheskaya problema meditsiny XXI veka [Comorbidity is an actual scientific and practical problem of the 21st century medicine]. Meditsinskie novosti, (8), 6 11. [in Russian].

DuGoff, E. H., Canudas-Romo, V., Buttorff, C., Leff, B., & Anderson, G. F. (2014). Multiple Chronic Conditions and Life Expectancy. Medical Care, 52(8), 688-694. https://doi.org/10.1097/mlr.0000000000000166

Abrahamovych, O., Fayura, O., & Abrahamovych, U. (2015). Komorbidnist: suchasnyi pohliad na problemu; klacyfikatsiia (povidomlennia pershe) [Comorbidity: a Modern View on the Problem; Classification (first notice)]. Lvivskyi klinichnyi visnyk, (1), 56 64. [in Ukrainian].

Oganov, R. G., Simanenkov, V. I., Bakulin, I. G., Bakulina, N. V., Barbarash, O. L., Boytsov, S. A., Boldueva, S. A., Garganeeva, N. P., Doshchitsin, V. L., Karateev, A. E., Kotovskaya, Yu. V., Lila, A. M., Lukyanov, M. M., Morozova, T. E., Pereverzev, A. P., Petrova, M. M., Pozdnyakov, Yu. M., Syrov, A. V., Tarasov, A. V., … Shalnova, S. A. (2019). Komorbidnaya patologiya v klinicheskoi praktike. Algoritmy diagnostiki i lecheniya [Comorbidities in clinical practice. Algorithms for diagnostics and treatment]. Kardiovaskulyarnaya terapiya i profilaktika, 18(1), 5-66. http://dx.doi.org/10.15829/1728-8800-2019-1-5-66 [in Russian].

Gudkov, R. A., & Konovalov, O. E. (2015). Komorbidnost', mul'timorbidnost', polipatii – tri vzglyada na sochetannye patologii [Comorbidity, multimorbidity, polypathy – three views on the combined pathology]. Vestnik RUDN, seriya Meditsina, (1), 39 45. [in Russian].

Fadieienko, G. D., & Nessen, A. O. (2015). Komorbidnist ta intehratyvna rol terapii vnutrishnikh khvorob [Comorbidity and integration role of therapy of internal diseases]. Ukrainskyi terapevtychnyi zhurnal, (2), 7 15. [in Ukrainian].

Sevinsky, R. E., Stewart, D. W., & Harirforoosh, S. (2017). Nonsteroidal anti-inflammatory drugs: Is there a link between cardiovascular and renal adverse effects? Journal of Integrative Nephrology and Andrology, 4(1), 1 2. https://doi.org/10.4103/jina.jina_2_17

National Institute for Health and Care Excellence (2016, September 21). Multimorbidity: clinical assessment and management. NICE. https://www.nice.org.uk/guidance/ng56.

Fialla, A. D., Israelsen, M., Hamberg, O., Krag, A., & Gluud, L. L. (2015). Nutritional therapy in cirrhosis or alcoholic hepatitis: a systematic review and meta-analysis. Liver International, 35(9), 2072–2078. https://doi.org/10.1111/liv.12798

Parikh, N. S., Navi, B. B., Schneider, Y., Jesudian, A., & Kamel, H. (2017). Association Between Cirrhosis and Stroke in a Nationally Representative Cohort. JAMA Neurology, 74(8), 927 932. https://doi.org/10.1001/jamaneurol.2017.0923

Wu, W. K. K., Zhang, L., & Chan, M. T. V. (2018). Autophagy, NAFLD and NAFLD-Related HCC. In J. Yu (Ed.). Obesity, Fatty Liver and Liver Cancer: Vol. 1061. Advances in Experimental Medicine and Biology (pp. 127-138). Springer. https://doi.org/10.1007/978-981-10-8684-7_10

Tsai, M.-C., Yang, T.-W., Wang, C.-C., Wang, Y.-T., Sung, W.-W., Tseng, M.-H., & Lin, C.-C. (2018). Favorable clinical outcome of nonalcoholic liver cirrhosis patients with coronary artery disease: A population-based study. World Journal of Gastroenterology, 24(31), 3547-3555. https://doi.org/10.3748/wjg.v24.i31.3547

Jepsen, P., Vilstrup, H., & Lash, T. L. (2014). Development and Validation of a Comorbidity Scoring System for Patients With Cirrhosis. Gastroenterology, 146(1), 147-156. https://doi.org/10.1053/j.gastro.2013.09.019


How to Cite

Matkovska NR, Virstiuk NH, Balan UV. Evaluation of comorbidity in patients with alcoholic cirrhosis of the liver associated with non-alcoholic fatty liver disease. Zaporozhye Medical Journal [Internet]. 2020Apr.13 [cited 2024Jul.17];22(2). Available from: http://zmj.zsmu.edu.ua/article/view/200574



Original research