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New liver health annual trends report

Market research survey report underscores need to address gaps in care and early diagnosis of chronic liver disease and cirrhosis

One of the challenges of chronic liver disease (CLD) is that its symptoms can be easily missed by those affected until it reaches an advanced stage1. Liver Awareness Month in October provides an important opportunity for health care practitioners to refocus efforts on prevention of CLD and raise awareness of its consequences if left untreated, particularly the risks of CLD progression to cirrhosis, including developing hepatic encephalopathy (HE). HE is a serious complication of cirrhosis that can manifest as a wide spectrum of neurological or psychiatric abnormalities2.

Between 2018 and 2019, mortality from CLD and cirrhosis rose at a rate of 3% per 100,000 in the specified group, the most current data available at the time the article was created3,4. According to data through July 2021, Covid-19 has had a substantial impact on patients with cirrhosis who are nearly 2.4 times more likely to die within 30 days of getting the virus than cirrhosis patients without Covid-195.

CLD misconceptions and most common complication

Liver disease is widely misunderstood. Nonalcoholic fatty liver disease (NAFLD) is the most common form of liver disease in the U.S. with a mortality rate associated with its progression to decompensated cirrhosis or hepatocellular carcinoma.

As many as 80% of people with cirrhosis may eventually develop HE, a complex disorder that is often difficult to diagnose because of its wide spectrum of symptoms – from very subtle to severe. HE may progress gradually over time from a mild disorder to a life-threatening one or can occur episodically2. Patients with HE who are readmitted to the hospital within 30 days of discharge have a 20% 1-year mortality rate6.

Even when symptoms are mild, HE can affect a person’s memory, concentration, and ability to perform daily functions such as driving. The more severe form of the disorder can cause confusion, disorientation, complete memory loss, and even result in a coma2.

Gaps in knowledge and care

To better understand the barriers that exist to quality care for CLD and cirrhotic patients, and associated complications such as HE, Salix Pharmaceuticals released the second edition of its Liver Health Annual Trends Report which includes results from a market research survey of 400 CLD health care providers and secondary research of published literature.

The survey showed that there are significant gaps in care and knowledge that prevent early diagnosis and optimal management of CLD and HE. In fact, 61% of patients feel that their health care provider does not do an adequate job educating them about their disease. With a projected shortage of 1,630 gastroenterologists by 2025, according to the U.S. Department of Health and Human Services, primary care physicians may need to treat CLD patients on a more regular basis7. Nearly 40% of providers, including community-based gastroenterologists, institution-based specialists, primary care physicians, nurse practitioners/physician assistants, were unaware or unable to name national guidelines for the treatment of CLD and almost one in five PCPs said that they did not know how to incorporate liver disease guidelines into their daily practice. Additionally, 55% of PCPs are not comfortable treating overt HE.

Responses for this market research were collected from an online survey and qualitative interviews during May 2022. Not all findings may be generalizable to the larger CLD provider and patient populations.
Secondary research from this report may not have reflected all published data, and a systematic review was not performed. While included publications were peer reviewed, the secondary research as a whole was not.

New ICD-10 code may help ensure patients clinical management is appropriate

Health practitioners, for the first time, will be able to use a specific HE diagnosis code (K76.82) as part of CMS’ ICD-10-CM codes to identify HE patients8. The use of the K76.82 code may provide previously unavailable information about HE, including data on its true impact across gender, race, age, and geographic location, among other demographics. A variety of nonspecific ICD-10 codes have been used in the past9. Additional benefits of the new ICD-10 code may include:

  • Helping ensure HE diagnosis is documented correctly which may address confusion concerning coverage criteria and may impact clinical management of the disease
  • Helping advance efforts to ensure patients’ clinical management is appropriate

CLD, cirrhosis, and its complications remain challenging to adequately address. Given its prevalence and increasing mortality rate10, it’s critical that all providers, from specialists to primary care practitioners, are aware of its signs, symptoms and complications, in particular HE, and how to diagnose and manage them early on.

For more information about trends in CLD, cirrhosis and HE, view the full Liver Health Annual Trends Report here. More information about HE is available for health care professionals at


  1. Gao E, Hercun J, Heller T, Vilarinho S. Undiagnosed liver diseases. Translational Gastroenterology and Hepatology. 2021;6:28-28. doi:10.21037/tgh.2020.04.04
  2. Vilstrup, H., et al. Hepatic encephalopathy in chronic liver disease: 2014 practice. aasld. Accessed October 6, 2022.
  3. Arias, E., & Xu, J. National Vital Statistics Reports Volume 70, Number 19. March 22, 2022. Accessed October 6, 2022
  4. Xu, J., Murphy, S., Kochanek, K., & Arias, E. (2021, July 26). National Vital Statistics Reports Volume 70, Number 8. Accessed October 6, 2022.
  5. Ge J, Pletcher MJ, Lai JC, Harper JR, Chute CG, Haendel MA. Outcomes of SARS-COV-2 infection in patients with chronic liver disease and cirrhosis: A national covid cohort collaborative study. Gastroenterology. 2021;161(5). doi:10.1053/j.gastro.2021.07.010
  6. Kruger AJ, Aberra F, Black SM, et al. A validated risk model for prediction of early readmission in patients with hepatic encephalopathy. Annals of Hepatology. 2019;18(2):310-317. doi:10.1016/j.aohep.2018.08.001
  7. U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health Workforce Analysis. 2016. Supply and Demand Projections for Internal Medicine Subspecialties: 2013-2025. Accessed October 6, 2022.
  8. 2023 ICD-10. (n.d.). Accessed October 6, 2022.
  9. Bloom PP, Tapper EB. The use of administrative data to investigate the population burden of hepatic encephalopathy. Journal of Clinical Medicine. 2020;9(11):3620. doi:10.3390/jcm9113620
  10. Estes C, Razavi H, Loomba R, Younossi Z, Sanyal AJ. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology. 2017;67(1):123-133. doi:10.1002/hep.29466