Liver and Bile
Eur J Gastroenterol Hepatol. 2024;36(1):89–96
Impact of continued alcohol use on liver-related outcomes of alcohol-associated cirrhosis: A retrospective study of 440 patients
Background and aim: The prevalence of alcohol-associated cirrhosis is increasing. In this respect, this study investigated the long-term impact of non-abstinence on the clinical course of alcohol-associated cirrhosis.
Methods: The authors 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. They 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 patients. 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; 95% confidence interval [CI]: 2.388–4.882; p < 0.001) along with the Child-Pugh class (HR = 4.453; 95% CI: 2.907–6.823; p < 0.001) and higher age (HR = 1.023; 95% 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.