Nearly 15% of patients with alcohol-related liver disease progress to decompensation
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Among patients with alcoholic-related liver disease in early stages, 15% progressed to decompensation and 22% died within 6 years, according to data presented at EASL Congress.
“Despite [alcohol-related liver disease] being highly prevalent, it is still largely under studied and overlooked as a research area,” Stine Johansen, MBBS, from the Odense University Hospital in Denmark, told attendees. “It is important to study the natural history of disease, as this information will help us improve diagnostic and treatment strategies and also help inform public health strategies and guidelines.”
To investigate the clinical course of biopsy-controlled, alcohol-related liver disease, Johansen and colleagues conducted a prospective study of 458 patients (mean age, 57 years; 76% men), of whom 57% were stage F0 to 1, 23% F2 and 20% F3 to 4, with a history of excessive alcohol consumption but no prior decompensation. Patients reported a median 15.5 years of excessive drinking.
Researchers performed liver biopsies at baseline, as well as blood tests and transient elastography measurements. Using the blood tests, they genotyped four single nucleotide polymorphisms in PNPLA3, MBOAT7, TM6SF2 and HSD17B13.
Patients were followed for a median 5.9 years, during which researchers reviewed medical health records for hospitalizations, new diagnoses or complications, reports of alcohol consumption and all-cause mortality.
First decompensation, which included overt ascites and hepatic encephalopathy and variceal bleeding, was reported in 67 patients (15%) during follow-up. Forty-six patients (10%) developed at least one additional decompensation and 101 (22%) patients died, Johansen said.
The cause of death was hepatic in 38% of cases and non-hepatic in 42%, while 20% died from an unknown cause.
“If we then look further into these non-hepatic deaths and unknown causes of death of those patients, 22% had cirrhosis when they died of a non-liver related death,” Johansen said.
As fibrosis stage increased, all-cause mortality also increased from 1.4 deaths per 100 person-years for stage F0 to 1 to five deaths per 100 person-years for stage F2 and 9.3 deaths per 100 person-years for stage F3 to 4.
Additionally, incidence of decompensation during follow-up increased from 1.9% for baseline stage F0 to 1 to 15.9% for stage F2 and 49.5% for stage F3 to 4.
Researchers reported that baseline fibrosis stage (HR = 3.11; 95% CI, 1.54-6.3) and excessive drinking (HR = 4.80; 95% CI, 3.28-7.02) were independent predictors of a first decompensation, while PNPLA3 and TM6SF2 did not have independent prognostic information.
“For patients with alcohol-related liver disease in earlier stages, we see a high progression rate — 15% progressed to decompensation,” Johansen said. “We also see high mortality rates, with 101 deaths within 6 years. Alcohol intake and fibrosis stage were the strongest predictors of events.”
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Johansen S, et al. Abstract OS-005-YI: Clinical course of biopsy-controlled alcohol-related liver disease. Presented at: EASL Congress; June 21-24, 2023; Vienna (hybrid meeting).
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