Alcohol‐related liver disease phenotype impacts survival after an acute variceal bleeding episode

• Published in: Liver international Vol. 43; no. 7; pp. 1548 - 1557
• Main Authors: Villagrasa, Ares, Hernández‐Gea, Virginia, Bataller, Ramon, Giráldez, Álvaro, Procopet, Bogdan, Amitrano, Lucio, Villanueva, Candid, Thabut, Dominique, Ibañez‐Samaniego, Luis, Albillos, Agustin, Bureau, Christophe, Trebicka, Jonel, Llop, Elba, Laleman, Wim, Palazon, J. M., Castellote, Jose, Rodrigues, Susana, Gluud, Lise L., Ferreira, Carlos N., Cañete, Nuria, Rodríguez, Manuel, Ferlitsch, Arnulf, Mundi, Jose L., Gronbaek, Henning, Hernández‐Guerra, Manuel, Sassatelli, Romano, Dell'Era, Alessandra, Senzolo, Marco, Abraldes, Juan G., Zipprich, Alexander, Casas, Meritxell, Masnou, Helena, Primignani, Massimo, Krag, Aleksander, Silva‐Junior, Gilberto, Romero‐Gómez, Manuel, Tantau, Marcel, Guardascione, Maria A., Alvarado, Edilmar, Rudler, Marika, Bañares, Rafael, Martinez, Javier, Robic, Marie A., Jansen, Christian, Calleja, Jose L., Nevens, Frederik, Bosch, Jaime, Ventura‐Cots, Meritxell, García‐Pagan, Juan C., Genescà, Joan
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-07-2023
• Subjects: abstinence; Alcohol; Alcohols; alcohol‐related hepatitis; Bleeding; Cirrhosis; Complications; Drinking behavior; Health hazards; Hepatitis; Liver; Liver cirrhosis; Liver diseases; Mortality; Phenotypes; Statistical models; Survival; upper gastrointestinal bleeding; alcohol; abstinence; alcohol-related hepatitis; cirrhosis; upper gastrointestinal bleeding
• ISSN: 1478-3223; 1478-3231
• DOI: 10.1111/liv.15606

Background & Aims
Alcohol‐related hepatitis (AH) encompasses a high mortality. AH might be a concomitant event in patients with acute variceal bleeding (AVB). The current study aimed to assess the prevalence of AH in patients with AVB and to compare the clinical outcomes of AH patients to other alcohol‐related liver disease (ALD) phenotypes and viral cirrhosis.
Methods
Multicentre, observational study including 916 patients with AVB falling under the next categories: AH (n = 99), ALD cirrhosis actively drinking (d‐ALD) (n = 285), ALD cirrhosis abstinent from alcohol (a‐ALD) (n = 227) and viral cirrhosis (n = 305). We used a Cox proportional hazards model to calculate adjusted hazard ratio (HR) of death adjusted by MELD.
Results
The prevalence of AH was 16% considering only ALD patients. AH patients exhibited more complications. Forty‐two days transplant‐free survival was worse among AH, but statistical differences were only observed between AH and d‐ALD groups (84 vs. 93%; p = 0.005), when adjusted by MELD no differences were observed between AH and the other groups. At one‐year, survival of AH patients (72.7%) was similar to the other groups; when adjusted by MELD mortality HR was better in AH compared to a‐ALD (0.48; 0.29–0.8, p = 0.004). Finally, active drinkers who remained abstinent presented better survival, independently of having AH.
Conclusions
Contrary to expected, AH patients with AVB present no worse one‐year survival than other patients with different alcohol‐related phenotypes or viral cirrhosis. Abstinence influences long‐term survival and could explain these counterintuitive results.