Long Term Mortality in Young Patients (<40 y/o) With Alcoholic Liver Cirrhosis After First Hospitalization: Carilion Clinic Experience

Abstract

Introduction: Long term mortality in young patients after their first hospitalization for alcoholic liver disease (ALC) is not well established. We aimed to evaluate the long term outcomes among young subjects with ALC after their first related hospitalization in a tertiary referral academic center. Methods: We searched the EPIC EMR and identified all patients hospitalized for ALC at Carilion Clinic, Roanoke from 2008-2016, and review outcomes through 6/2018. Information on demographics, comorbidities, lab values, procedures, and mortality were extracted. Cumulative risks of long-term mortality after the first hospitalization were estimated using Kaplan-Meier curves and compared between two groups; those 40 years of age. Demographic data, lab values, and comorbidities associated with cirrhosis were assessed using multivariate Cox proportional hazard analysis to determine risk factors associated with long-term mortality. Results: We identified Sixty-five young patients out of a total of 325 patients admitted for the first time for ALC (mean age, 34.6±4.7 years; 72.3% males, 48.4% current alcohol use, 67.2% current smokers, 15.8% current illicit drugs use). Seven (10.8%) had biopsy-proven ALC, others were diagnosed clinically. Over a mean follow-up of 1.3±2.0 years, twenty patients (30.8%) died. The mean number of hospitalizations was 2.3±2.2. The 1-, 3- and 5-years cumulative mortality was 21.1 %, 31.1% and 49.7% respectively. The median survival for young patients was longer as compared old patients (p<0.001); this was likely related to extra hepatic comorbidities. Mortality in those younger than 40 was lower than in older patients (P less than 0.001). On multivariate Cox proportional hazard analysis (HR), increased age (HR 1.04; 95% CI, 1.02-1.06), neutrophils-to-lymphocytes ratio (NLR) (HR 1.02; 95% CI, 1.001-1.038), and initial MELD score (HR 1.14; 95% CI, 1.08-1.21) were found to be associated with long-term mortality. Current tobacco (HR 1.07, p=0.08) and alcohol use (HR 1.23, p=0.09) were not found to be risk factors for long-term mortality. Conclusion: 5-year cumulative mortality for patients younger than 40 years of age with ALC after their first hospitalization is 49.7% despite quitting drinking in about 50% of the patients. Old age, most recent NLR, and initial MELD score were associated with increased risk for late mortality.