P74 Poor survival across CLD aetiologies in individuals presenting acutely in an emergency setting

<h3>Background</h3> Chronic liver disease (CLD) carries major morbidity and mortality burdens in the UK, with CLD deaths increasing substantially in recent decades. Many individuals with CLD present for the first time in emergency medical settings with already advanced disease, and 25% die within the first 60 days following index first emergency admission (FEA). The major CLD aetiologies accounting for most of the attributable disease burden are alcohol-related and metabolic dysfunction-associated steatotic liver disease. The extent to which long-term survival varies between these disease subtypes requires investigation and quantification. <h3>Methods</h3> National administrative hospital data were analyzed to construct a cohort of all adult patients in England with an FEA for CLD between 1 April 2012 and 31 March 2019. CLD aetiology was ascertained from ICD-10 diagnostic codes available in routinely collected hospital data; aetiological categories are not mutually exclusive. Linkage to ONS death registrations enabled identification of death within first year following EA. Cumulative incidence of death from any cause throughout entire study duration was calculated, stratified by aetiology. <h3>Findings</h3> The cohort was comprised a total of 82, 402 individuals of whom 52, 504 (63.7%) died during the study period, with a median time to death of 2.7 years. The majority (61.7%) of individuals were males, and median age at admission for the cohort was 57 years (IQR 20 years). Most individuals presented with alcoholic liver disease (ARLD) aetiology (64.5%, n = 53,105), with minorities presenting with metabolic aetiologies (7.6%, n = 6, 256) and both aetiologies combined (4.3%, n = 2, 297). Small proportions presented with other viral (6.1%, n = 5,007), autoimmune (3.1%, n = 2, 586) and other viral (2.6%, n = 2, 114) disease subtypes. The proportion of individuals with metabolic disease increased during the study period. In all non-autoimmune, over 50% of individuals had died within 5 years following FEA. Differences in deaths between CLD aetiologies was significant (figure 1, p &lt; 0.0001) and median time to 50% survival in those with ARLD was 2.75 years (95% CI 2.67–2.83 years), 3.20 years for metabolic disease (95% CI 2.98–3.47 years), 4.36 years for viral disease (95% CI 4.01–4.88 years), 0.9 years for other disease (95% CI 0.7–1.2 years), and 6.84 years for autoimmune disease (95% CI 6.15–7.62 years). <h3>Conclusions</h3> Survival is very poor across all individuals presenting acutely in an emergency hospital setting for CLD, with the poorest survival observed in individuals with alcoholic liver disease.