Heavy alcohol use increases liver impairment, risk for HCC in hepatitis-induced cirrhosis
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Among patients with hepatitis-induced cirrhosis, heavy alcohol consumption increased liver function impairment and hepatocellular carcinoma prevalence, according to research.
“The interaction between alcohol and hepatitis virus B or C has been widely studied recently with non-unanimous conclusions. Heavy alcohol consumption had been shown to accelerate the development of liver fibrosis and to increase the prevalence of HCC and mortality in HCV infected patients. Concerning the interaction between alcohol and HBV, less conclusive studies have been done,” Kodjo-Kunale Abassa, from the department of gastroenterology at The Third Affiliated Hospital of Sun Yat-Sen University in China, and colleagues wrote. “Nevertheless, more needs to be explored about the prevalence of other liver cirrhosis complications such as esophageal and gastric variceal bleeding (EGVB) among these groups of patients.”
To investigate the influence of alcohol on clinical outcomes in patients with HBV and HCV-induced liver cirrhosis, researchers retrospectively reviewed medical records of 22,287 patients (mean age, 52 years; 84.1% men) diagnosed with liver cirrhosis from January 2010 to December 2019. They divided patients into groups by etiology (alcohol-induced liver disease [ALD]: 1,652; HBV: 18,079; HCV: 682; combined ALD and HBV: 1,594; and combined ALD and HCV: 280) and compared liver function impairment severity and liver cirrhosis complications using laboratory data.
Compared with the HBV group, a greater proportion of patients in the combined ALD and HBV group had a Child Pugh grade C (18.8% vs. 28%; P < .001) or Model for End-Stage Liver Disease (MELD) score greater than 18 (18.5% vs. 24.1%; P < .001) with a 2.01-fold and 1.74-fold higher risk for HCC (OR = 2.01; 95% CI, 1.58-2.55) and EGVB (OR = 1.74; 95% CI, 1.3-2.33). Similarly, compared with the HCV group, a greater proportion of patients in the combined ALD and HCV group had a MELD score greater than 18 (7.6% vs. 13.3%; P < .05).
Researchers noted a decreased risk for HCC and EGVB following alcohol abstinence; patients who abstained from alcohol use and received antiviral treatment had the lowest risk for HCC (OR = 0.1; 95% CI, 0.05-0.2) and EGVB (OR = 0.17; 95% CI, 0.06-0.45).
“Alcohol increased significantly the severity of liver function impairment and the prevalence of liver cirrhosis complications, particularly HCC and EGVB, in hepatitis virus-induced liver cirrhosis patients (HBV and HCV),” Abassa and colleagues concluded. “Remarkably, long-term abstinence from alcohol coupled with efficient antiviral treatment effectively decreased the prevalence of HCC and EGVB in these populations, thus the importance of stressing not only on the importance of antiviral treatment in patients with coexisting ALD and viral cirrhosis, but also on long-term alcohol abstinence.”
Perspective
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Shreya Sengupta, MD
This article highlights the importance of screening all patients, especially those with liver disease of any etiology, for alcohol use and its negative effects. As noted in this article, patients with viral hepatitis — in particular, hepatitis B and C — both had worse outcomes if alcohol use was in the picture. Once alcohol use stopped, both sets of patients had better outcomes with regard to overall disease severity, complications of liver disease like variceal bleeding (blood loss from large blood vessels in the GI tract), and liver cancer or hepatocellular carcinoma.
Previous studies have shown that alcohol increases the amount of HBV replicating in the blood stream, and the same is theorized for HCV. This means that adding alcohol into the picture not only causes liver damage from alcohol itself but makes the amount of circulating HBV and HCV increase as well, which causes further liver inflammation and damage. Not only is it important to identify patients with viral hepatitis and treat appropriately but being aware of alcohol use and its additive negative effects is important and can markedly change outcomes for patients with liver disease of other etiologies.
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