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Alcohol consumption only predictive factor for alcoholic hepatitis survival

Abstinence from alcohol was the only factor independently associated with improved long-term survival among patients with severe alcoholic hepatitis in a recent retrospective study.

Researchers evaluated data from 109 patients with severe alcoholic hepatitis (SAH) for a median follow-up of 40.7 months between January 2006 and August 2011.

Death occurred in 57.8% of the cohort with an overall median survival of 22.4 months. Nearly all deaths were liver-related (96.8%), with 65.1% of deaths following index hospitalization. Investigators estimated a 5-year survival rate of 31.8%, and observed a significant association between mortality in the short term and hepatorenal syndrome at baseline (HR=3.842; 95% CI, 2.018-7.312; median survival 0.52 months).

Of 87 patients who survived index hospitalization, 65.1% either continued drinking throughout the study or abstained and later relapsed. Patients who abstained were less likely to be readmitted to the hospital (1 case vs. 5 cases; P=.001) and had better median MELD scores (13.5 vs. 9.4; P=.008) and CPS (8 vs. 6; P=.031) than those who continued to drink or relapsed.

Multivariate analysis indicated that alcohol abstinence after follow-up was independently predictive of survival (HR=0.37; 95% CI, 0.168-0.818), with a 5-year survival rate of 75.3% among those who abstained vs. 26.8% among relapsers and 21% among continued drinkers (P=.005 for difference). This protective effect was not significant at 12 months (HR=1.714; 95% CI, 0.612-4.802), neared significance at 18 months (HR=2.714; 95% CI, 0.995-7.404) and achieved significance at 24 months after hospital discharge (HR=3.207; 95% CI, 1.224-8.4).

“Alcohol use at the last follow-up remains the only independent predictor of long-term outcome, 5-year survival being approximately three-fold higher in abstainers than continued drinkers,” the researchers wrote. “Our data are worrying, especially in light of the rising tide of ALD in the UK. The continued focus on short-term survival as the goal for therapy ignores the significant burden of late-stage mortality in SAH as demonstrated by this study.”

Disclosure: Researcher Sumita Verma reported serving on an advisory board for Janssen and receiving research funding from Janssen and Gilead and travel grants from Gilead and Bristol-Myers Squibb.