Alcohol Consumption After Alcohol-Related Cirrhosis Linked to Poor Outcomes

No alcohol consumption can be regarded as safe after an individual has developed cirrhosis.

Among patients with alcohol-related cirrhosis, outcomes are poorer among patients who have any alcohol recurrence. These prospective study findings were published in the Journal of Hepatology.

Patients (N=650) with compensated cirrhosis and a history of excessive alcohol consumption were recruited from 20 centers in France and 2 centers in Belgium between 2010 and 2016. Change in alcohol consumption was evaluated during a prospective follow-up and the amount of alcohol consumed was associated with outcomes. Alcohol consumption was calculated using glasses-year, in which 1 glass-year was defined as consuming 1 alcoholic beverage equivalent to 10 g of pure alcohol every day for 1 year. Consumption was similarly quantified for glasses/week.

Among the study population, the median age was 58.4 (IQR, 51.2-64.3) years, 67.4% were men, median body mass index was 27.8 (IQR, 24.3-30.9) kg/m2, 63.8% had a history of decompensation, duration of alcohol consumption was 10 (IQR, 2-30) years, and past alcohol consumption was 55 (IQR, 8.9-156) glasses-years. At baseline, 456 participants had been abstinent from alcohol for a median of 24 months, in which the alcohol abstainers were younger, more likely to be women, had a history of decompensation, and consumed more alcohol in the past (all P £.017) compared with non-abstinent individuals.

Among the participants who consumed alcohol, 49.0% consumed 1 to 6 glasses/week, 24.2% consumed 7 to 27 glasses/week, and 26.8% consumed 28 or more glasses/week.

Among those who were alcohol abstinent at baseline, 18.3% had a recurrence at 24 months and 30.9% had a recurrence at 60 months.

To avoid liver events and death, patients with compensated alcohol-related cirrhosis should be advised to completely discontinue alcohol intake, even small amounts.

In the multivariate model, alcohol relapse was associated with substance use disorder (subdistribution hazard ratio [sHR], 2.06; 95% CI, 1.06-3.99; P =.033) and years since alcohol weaning (sHR, 0.93; 95% CI, 0.86-0.99; P =.042).

During follow-up, 97 participants had a liver decompensation event, 61 developed hepatic cellular carcinoma (HCC), 3 received a liver transplant, and 156 died. Deaths occurred due to cirrhosis (n=64), HCC (n=18), non-HCC malignancy (n=26), cardiovascular causes (n=15), other causes (n=17), or unknown causes (n=13). The median liver event-free survival was 82.9 months, and survival was 97 months.

Complication-free survival was less likely among participants with Child-Pugh a score greater than A5 (hazard ratio [HR], 1.92; 95% CI, 1.38-2.68; P =.00012), 1 to 6 (HR, 1.83; 95% CI, 1.19-2.81; P =.027) and at least 28 (HR, 1.67; 95% CI, 1.02-2.76; P =.020) glasses/week consumption compared with abstinence and age per 10 years (HR, 1.20; 95% CI, 1.02-1.41; P =.030).

Decreased survival risk was associated with a Child-Pugh score greater than A5 (HR, 2.11; 95% CI, 1.44-3.10; P =.0001), 1 to 6 (HR, 1.76; 95% CI, 1.07-2.90; P =.027) and 28 or more (HR, 1.34; 95% CI, 1.11-3.38; P =.020) glasses/week compared with abstinence, glasses-years greater than 25 (HR, 1.50; 95% CI, 1.02-2.22; P =.041), age per 10 years (HR, 1.27; 95% CI, 1.05-1.54; P =.013), and creatinine per 10 mmol/L (HR, 1.03; 95% CI, 1.003-1.07; P =.034).

The major limitation of this study was the possibility that some patients underreported their alcohol consumption.

The study authors conclude, “To avoid liver events and death, patients with compensated alcohol-related cirrhosis should be advised to completely discontinue alcohol intake, even small amounts.”

References:

Louvet A, Bourcier V, Archambeaud I, et al. Low alcohol consumption influences outcomes in individuals with alcohol-related compensated cirrhosis in a French multicenter cohort. J Hepatol. 2022;S0168-8278(22)03304-9. doi:10.1016/j.jhep.2022.11.013