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

BackgroundCirrhosis 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.MethodsWe searched electronic databases, including Pubmed/Medline, Scopus, and Embase. We included original studies that reported the etiology of cirrhosis in the Indian population.ResultsWe included 158 studies (adults: 147, children: 11). The overall pooled estimate of alcohol as a cause of cirrhosis in adults was 43·2% (95% CI 39·8-46·6%; I2=97·8%), followed by NAFLD/Cryptogenic in 14·4% (11·7-17·3%; I2=98·4%), HBV in 11·5% (95% CI 9·8-13·3%; I2=96·6%), and 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% (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% (0·0-8·5%; I2=94·6%).ConclusionsAlcohol is the most common etiology of cirrhosis in adults in India. The proportions of alcohol and non-alcoholic fatty liver disease-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.