Etiology and mode of presentation of chronic liver diseases in India: A multi centric study

PLoS One. 2017 Oct 26;12(10):e0187033. doi: 10.1371/journal.pone.0187033. eCollection 2017.


There is a paucity of health policy relevant data for chronic liver disease from India, impeding formulation of an interventional strategy to address the issue. A prospective, multicentric study to delineate the etiology and clinical profile of chronic liver disease in India is reported here. A centrally coordinated and monitored web-based data repository was developed (Feb, 2010 to Jan, 2013) and analyzed. Eleven hospitals from different parts of India participated. Data were uploaded into a web based proforma and monitored by a single centre according to a standardized protocol. 1.28% (n = 266621) of all patients (n = 20701383) attending the eleven participating hospitals of India had liver disease. 65807 (24·68%) were diagnosed for the first time (new cases). Of these, 13014 (19·77%, median age 43 years, 73% males) cases of chronic liver disease were finally analyzed. 33.9% presented with decompensated cirrhosis. Alcoholism (34·3% of 4413) was the commonest cause of cirrhosis while Hepatitis B (33·3%) was predominant cause of chronic liver disease in general and non-cirrhotic chronic liver disease (40·8% out of 8163). There was significant interregional differences (hepatitis C in North, hepatitis B in East and South, alcohol in North-east, Non-alcoholic Fatty Liver Disease in West) in the predominant cause of chronic liver disease. Hepatitis B (46·8% of 438 cases) was the commonest cause of hepatocellular Cancer.11·7% had diabetes. Observations of our study will help guide a contextually relevant liver care policy for India and could serve as a framework for similar endeavor in other developing countries as well.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Chronic Disease / epidemiology
  • Female
  • Health Facilities / statistics & numerical data
  • Health Services Accessibility / statistics & numerical data
  • Humans
  • India / epidemiology
  • Infant
  • Liver Diseases / epidemiology*
  • Liver Diseases / etiology*
  • Male
  • Middle Aged
  • Young Adult

Grants and funding

Financial support for this study was provided by the Bristol-Myers Squibb Foundation, USA to Liver Foundation, West Bengal through Delivering Hope program ( responsibility/bristol-myers-squibb-foundation/our-focus-areas/hepatitis-b-andc/ liver-foundation-west-bengal.html). Funding agency had no role in the study design, data collection, analysis and interpretation, decision to publish, or manuscript preparation. Authors were not paid by the funding agency for writing this article. Corresponding author, AC, had full access to the data and had final responsibility for the decision to publish. None of the authors is related to the funding agency in terms of employment, consultancy, patents, and products in development or marketed products or in any other way.