Impact of continued alcohol use on liver-related outcomes of alcohol-associated cirrhosis: a retrospective study of 440 patients

Abstract

Background and aim The prevalence of alcohol-associated cirrhosis is increasing. In this respect, we investigated the long-term impact of non-abstinence on the clinical course of alcohol-associated cirrhosis. Methods We retrospectively evaluated 440 patients with alcohol-associated cirrhosis (compensated cirrhosis: n = 190; decompensated cirrhosis: n = 250) diagnosed between January 2000 and July 2017 who consumed alcohol until diagnosis of cirrhosis. We assessed liver-related outcomes including first and further decompensating events (ascites, variceal bleeding, and hepatic encephalopathy), and death in relation to continued alcohol use. Results Overall, 53.6% of patients remained abstinent (compensated cirrhosis: 57.9%; decompensated cirrhosis: 50.4%). Non-abstinent versus abstinent patients with compensated cirrhosis and decompensated cirrhosis showed significantly higher 5-year probability of first decompensation (80.2% vs. 36.8%; P < 0.001) and further decompensation (87.9% vs. 20.6%; P < 0.001), respectively. Five-year survival was substantially lower among non-abstinent patients with compensated cirrhosis (45.9% vs. 90.7%; P < 0.001) and decompensated cirrhosis (22.9% vs. 73.8%; P < 0.001) compared to abstinent. Non-abstinent versus abstinent patients of the total cohort showed an exceedingly lower 5-year survival (32.2% vs. 82.4%; P < 0.001). Prolonged abstinence (≥2 years) was required to influence outcomes. Non-abstinence independently predicted mortality in the total cohort (hazard ratio [HR] 3.371; confidence interval [CI]: 2.388–4.882; P < 0.001) along with the Child-Pugh class (HR: 4.453; CI: 2.907–6.823; P < 0.001) and higher age (HR: 1.023; CI: 1.007–1.039; P = 0.005). Conclusion Liver-related outcomes are worse among non-abstinent patients with alcohol- associated cirrhosis prompting urgent interventions ensuring abstinence.

Impact of low alcohol consumption in the natural history of cirrhosis

“…In ALD cirrhosis, the risk of either death or liver complications was higher in non-abstinent patients, increasing in a dose-dependent manner from a low consumption level (1–6 glasses/week) to the greatest consumption level (≥28 glasses/week). These results have been recently corroborated in an independent Greek cohort ( 10 ). Thus, low-to-moderate alcohol consumption (1–7 glasses/week for women and 1–14 glasses/week for men) might likely increase the likelihood of adverse outcomes in ALD and MASLD cirrhotic patients ( 4 , 5 ).…”

Association of left ventricular diastolic dysfunction with inflammatory activity, renal dysfunction, and liver-related mortality in patients with cirrhosis and ascites

“…We are aware that the main limitation of our study is that LVDD was defined by the 2009 and not newer ASE criteria [4] taking into account that our study was designed and initiated in 2014. Yet, it must be noted that the 2009 criteria are the most commonly employed criteria for LVDD definition in patients with cirrhosis [8–12,18,35–38] enabling the comparison of the results of different studies. Another potential limitation is that left atrial volume was not implemented for the diagnosis of LVDD.…”

“…On the scheduled days, ERPF and GFR were evaluated as previously reported [18]. In brief, an activity of approximately 111 MBq (3 mCi) of 99mTechnetium-mercapto-acetyl-triglycine (99mTc-MAG3; NephroMAG 0.2 mg, ROTOP Pharmaka GmbH, Dresden, Germany), or 148 MBq (5 mCi) of 99mTc-diethylene-triamine-pentaacetic acid (99mTc-DTPA; PENTACIS, CIS bio international, Saclay, France), were injected bolus intravenously for the calculation of the ERPF and the GFR, respectively.…”