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

Abstract

Introduction: Alcoholic liver cirrhosis (ALC) is increasingly diagnosed in young patients. Liver transplantation (LT) in these cases remains highly controversial, while the mortality of young patients after their first hospitalization for ALC is not well established. we aimed to evaluate the short 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. All available data was analyzed looking at 3-month outcomes. Information on demographics, comorbidities, lab values, procedures, and mortality were extracted. The cumulative risk of mortality in the first 3 ± 1 months after hospitalization were estimated using Kaplan-Meier curves and compared between two groups; those 40 years of age. Demographic data, lab values, and associated comorbidities were assessed using multivariate Cox proportional hazard analysis (HR) to determine risk factors associated with short-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 users). Seven (10.8%) had biopsy-proven ALC and the rest were diagnosed clinically. Over a median (interquartile range) follow-up of 2.4 months (0.24-3.24), nine (13.8%) died. The 1 and 3 months cumulative mortality after first hospitalization was 3.1 %, and 14.6% respectively. Mortality in those younger 40 years old was lower than in older patients (P less than 0.001); this was likely related to extra hepatic comorbidities in older patients. On multivariate Cox proportional hazard analysis, hepatic encephalopathy (HR 2.53; 95% CI, 1.36-4.89), and the presence of ascites (HR 2.07; 95% CI, 1.12-3.96) were associated with increased risk of early mortality. Current tobacco (HR 1.07, p=0.08), drug use (HR 1.66, p=0.197), alcohol use (HR 1.23, p=0.09), older age (HR 1.03; 95% CI, 1.01-1.06) and MELD score on admission (HR 1.07; CI, 1.01-1.12) were not found to be risk factors for short-term mortality. Conclusion: Short-term mortality for patients younger than 40 years of age with ALC after their first hospitalization is 14%, which is lower than the mortality for older patients. Hepatic encephalopathy and ascites seem to significantly impact mortality.