Unhealthy Alcohol Use Raises Mortality Rate in Cirrhosis Patients

Meredith M. Pearson, MD

Alcohol use is directly tied to mortality rates and other negative liver disease outcomes for patients with cirrhosis.

Among the negative effects of alcohol use and abuse is hepatic necroinflammation and worsening portal hypertension for patients with cirrhosis.

A team, led by Meredith M. Pearson, MD, Division of Gastroenterology and Hepatology, University of Washington, evaluated the associations between the degree of alcohol use and clinical liver-related outcomes based on the etiology of cirrhosis.

The Analysis

In the retrospective cohort study, the investigators identified 44,349 US veterans with cirrhosis from alcohol-associated liver disease (ALD), chronic hepatitis C virus (HCV) infections, or nonalcoholic fatty liver disease (NAFLD). Each patient completed an Alcohol Use Disorders Identification Test Consumption questionnaire in 2012.

The investigators used the result to categorize the level of alcohol for each participant as none, low level, or unhealthy. The team also conducted Multivariable Cox proportional hazards regression to assess associations between alcohol use and mortality, cirrhosis decompensation, labeled as new ascites, encephalopathy, or variceal bleeding, and hepatocellular carcinoma (HCC).

The baseline analysis shows 36.4% of patients endorsed alcohol use and 17.1% had unhealthily used alcohol. There was a mean of 4.9 years of follow-up and 57.9% (n = 25,806) patients died. In addition, 21.4% (n = 9409) of patients developed a new decompensation and 11.% (n = 4733) of participants developed HCC.

However, the most severe outcomes occurred in patients with a history of unhealthy alcohol use.

Outcomes

For patients with ALD-cirrhosis and HCV-cirrhosis, unhealthy alcohol use was associated with higher risks of mortality compared to no alcohol use (aHR, 1.13; 95% CI, 1.07-1.19 and aHR, 1.14; 95% CI, 1.08-1.20, respectively).

However, alcohol use was not associated with HCC, regardless of cirrhosis etiology.

“Unhealthy alcohol use was common in patients with cirrhosis and was associated with higher risks of mortality and cirrhosis decompensation in patients with HCV-cirrhosis and ALD-cirrhosis,” the authors wrote. “Therefore, health care providers should make every effort to help patients achieve abstinence. The lack of association between alcohol use and HCC merits further investigation.”

HCV Patients with Cirrhosis

Recent study results highlight the need to develop better surveillance techniques for whether a patient who achieved a sustained virologic response following treatment for HCV will develop cirrhosis.

A team, led by Teresa Broquetas, Liver Section, Gastroenterology Department, Hospital del Mar, evaluated the accuracy of transient elastography (TE) at identifying cirrhosis 3 years following HCV-eradication.

The best variable to predict cirrhosis after sustained virologic response (area under the receiver operating characteristic [AUROC], 0.79) was transient elastography prior to DAA treatment.

In addition, a number of measures, including liver function parameters, serological non-invasive tests, and transient elastography values improved following sustained virologic responses.

Liver biopsies 3 years after the hepatitis C virus has been eliminated with a median time of 38.4 months helped identify cirrhosis in 53.9% (n = 41) of patients.

After the investigators conducted a multivariate analysis, they found HCV genotype 3 (OR, 20.81; 95% CI, 2.12-201.47; P = 0.009) and transient elastography prior to DAA therapy (OR, 1.21; 95% CI, 1.09-1.34; P <0.001) were deemed the only variables linked to cirrhosis following a sustained virologic response.

Despite this, the accuracy of transient elastography following sustained virologic response was considered poor (AUROC, 0.75), with 27.3% (n = 6) of patients with transient elastography less than 8 kPa having cirrhosis. There were similar results found in the serological non-invasive tests of APRI and FIB-4.

The study, “Associations Between Alcohol Use and Liver-Related Outcomes in a Large National Cohort of Patients With Cirrhosis,” was published online in Hepatology Communications.