Abstract
Recurrent episodes of liver injury may either waste hepatic reserve or induce tolerance to further injury. We aimed to investigate whether the previous acute decompensation (AD) in liver cirrhosis (LC) affects the long-term transplant-free survival of patients with alcoholic hepatitis (AH). The survival data of 894 alcoholic LC cohort who had been admitted with acute deterioration in 21 academic hospitals in Korea were prospectively followed up. Enrolled patients were divided into three groups: Group 1, without AH; group 2, with nonsevere AH; and group 3, with severe AH. Although the baseline liver function was not different between the groups with or without previous AD, it was a significant predictor of poor long-term outcomes. The presence of previous AD negatively affected long-term overall survival (HR 1.62, 95% C.I. 1.20–2.18, p = 0.002) in groups 1 and 2 as a whole, independent of the Model for End-stage Liver Disease score. The three-month conditional survival was significantly worse in group 3 for up to 12 months in the presence of previous AD (p < 0.05). We concluded that not only the severity of AH, but also the prior AD is an important predictor of long-term outcomes in alcoholic LC patients with acute deterioration.
Highlights
Alcoholic hepatitis (AH) is a clinical syndrome distinguished by a recent onset of jaundice with an increased risk of liver-related events [1]
AH can occur in any stage of alcoholic liver disease; most patients with severe AH already have coexisting liver cirrhosis (LC) [2]
We found that a previous history of acute decompensation (AD) was a significant factor for mortality in alcoholic LC patients with acute deteriorating events independent of baseline hepatic function
Summary
Alcoholic hepatitis (AH) is a clinical syndrome distinguished by a recent onset of jaundice with an increased risk of liver-related events [1]. A potential commonality between severe AH and LC is that previous experience of acute decompensation (such as over ascites, hepatic encephalopathy, and gastrointestinal bleeding) may be an important prognostic factor for the natural course of AH, as it is in alcohol-related (alcoholic) LC. The baseline Model for End-Stage Liver Disease (MELD) score and Lille model were significant factors for the short-term prognosis of severe AH patients [6]. The MELD score and Lille model do not consider the development or severity of organ failure other than liver and kidney failures, and these other organ failures can significantly affect the short-term mortality of severe AH patients
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