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Addiction therapy for those with alcoholic hepatitis improves survival

Complete abstinence of alcohol consumption after an episode of alcoholic hepatitis improved long-term survival, according to data from a recently published study. The researchers advise that early initiation of addiction counseling may therefore also improve survival by avoiding recidivism.

“The risks of resuming alcohol use should not be understated,” the researchers wrote. “In one study, a significant portion of patients with recidivism developed a subsequent episode of [alcoholic hepatitis] that was more severe than the index episode with [approximately] 60% mortality. Identification of patients with high risk of recidivism is relevant because it can be used to select patients for salvage transplantation and to identify those patients needing more intense alcohol therapy.”

To determine the effect of abstinence on long-term survival and the predicting factors associated with recidivism vs. continued abstinence, the researchers reviewed the case data of 142 patients with biopsy-proven alcoholic hepatitis from 1999 to 2012. Median age of patients was 50 years, 69% were men and nearly 30% had a psychiatric comorbidity such as depression, anxiety or personality disorders. Median reported alcohol intake was 100 grams per day (range, 80-130) and 28 patients reported regular intake of over 20 alcoholic drinks per day.

At the end of follow-up (range, 17-84 months), 88 patients were alive and 54 were deceased. Mortality was liver related in 47 patients. Compared with the living patients, deceased patients were older at baseline (52 vs. 48 years; P < .05), more often men (80% vs. 62%; P = .02), more often had a longer duration of heavy drinking (12-24 years vs. less or more; P = .019) and more often resumed drinking after diagnosis (70% vs. 55%). Additionally, 36% of patients who maintained complete abstinence had at least one liver decompensation requiring admission during follow-up compared with 58% of those who resumed drinking (P = .009).

“We found that continued alcohol consumption is associated with a poorer long-term survival after an episode of [alcoholic hepatitis], which has important implications in the management of these patients,” the researchers concluded. “Our results strongly indicate that maneuvers aimed at promoting alcohol abstinence should be initiated as early as possible in patients hospitalized with [alcoholic hepatitis]. Ideally, multidisciplinary teams including addiction therapists should contribute in the integral treatment of these patients.” – by Talitha Bennett

Disclosure: Altamirano reports no relevant financial disclosures. Please see the full study for the other researchers’ relevant financial disclosures.