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AMSTERDAM -- Severe gum disease and advanced cirrhosis don't go together well.

A prospective analysis of patients with both cirrhosis and periodontitis showed more severe gum disease was associated with an increased risk of death from any case, according to Lea Ladegaard Grønkjaer, RN, PhD, of Aarhus University Hospital in Denmark.

The association was even greater when the researchers looked just at deaths related to the cirrhosis, Grønkjaer reported here at the , the annual meeting of the European Association for the Study of the Liver (EASL).

The study "showed that severe periodontitis strongly predicted higher mortality in cirrhosis," Grønkjaer said, possibly because the gum disease acts as a source for pathogens that can cause inflammation and increase the complications of cirrhosis.

But since the condition can be treated, she said, it might be possible to intervene and prevent the excess mortality.

"We hope that our findings motivate more trials on this subject," Grønkjaer said.

Indeed, finding that the two conditions are associated in a way that is tied to increased mortality is important but just the first step, commented Philip Newsome, MD, of the University of Birmingham in England.

"Further studies are now required to determine if improving gum care can improve outcomes in patients with liver cirrhosis," said Newsome, a member of the EASL governing board, who was not part of the study.

Periodontitis is common in adults in Europe, Grønkjaer noted, affecting some 35%, of whom up to 15% have a severe form of the disease. The prevalence is even higher in the U.S.:

A range of studies has linked periodontitis and such things as cardiovascular disease, kidney disease, diabetes, and respiratory diseases and moreover, she said, poor oral health is very common among people with cirrhosis.

To study the issue, Grønkjaer and colleagues enrolled 184 consecutive cirrhosis patients whose oral health was assessed. Of those, she reported, 44% had severe periodontitis, according to standard criteria: two or more sites with a clinical attachment level of 6 mm or more on different teeth and one or more sites with a probing depth of 5 mm or more.

There were few significant differences between the patients with severe disease and those with less severe or no disease:

• Patients with severe disease were more likely to have an alcoholic etiology for their cirrhosis, while those with less severe disease were more likely to have an autoimmune or cholestatic etiology.
• Patients with severe disease were more likely to be current or former smokers and less likely to have never smoked.

All told, patients were followed for 74,197 days, or an average of 350 days per patient. During that time, 44% of the participants died.

The bottom line, Grønkjaer and colleagues found, was that patients with severe periodontitis were more likely to die for any reason, with a crude hazard ratio for all-cause mortality of 1.56.

When the analysis was adjusted to take into account demographic factors, including such things as age, sex, cirrhosis etiology, smoking, alcohol use, and comorbidities, the hazard ratio was only slightly changed, to 1.45.

The association was even stronger with higher cirrhosis-related mortality, where the researchers found a crude hazard ratio of 2.19 and an adjusted hazard ratio of 2.29.

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