Alcohol Consumption After Alcohol-Related Cirrhosis Linked to Poor Outcomes

No alcohol consumption can be regarded as safe after an individual has developed cirrhosis.

Among patients with alcohol-related cirrhosis, outcomes are poorer among patients who have any alcohol recurrence. These prospective study findings were published in the Journal of Hepatology.

Patients (N=650) with compensated cirrhosis and a history of excessive alcohol consumption were recruited from 20 centers in France and 2 centers in Belgium between 2010 and 2016. Change in alcohol consumption was evaluated during a prospective follow-up and the amount of alcohol consumed was associated with outcomes. Alcohol consumption was calculated using glasses-year, in which 1 glass-year was defined as consuming 1 alcoholic beverage equivalent to 10 g of pure alcohol every day for 1 year. Consumption was similarly quantified for glasses/week.

Among the study population, the median age was 58.4 (IQR, 51.2-64.3) years, 67.4% were men, median body mass index was 27.8 (IQR, 24.3-30.9) kg/m2, 63.8% had a history of decompensation, duration of alcohol consumption was 10 (IQR, 2-30) years, and past alcohol consumption was 55 (IQR, 8.9-156) glasses-years. At baseline, 456 participants had been abstinent from alcohol for a median of 24 months, in which the alcohol abstainers were younger, more likely to be women, had a history of decompensation, and consumed more alcohol in the past (all P ≤.017) compared with nonabstinent individuals.

Among the participants who consumed alcohol, 49.0% consumed 1 to 6 glasses/week, 24.2% consumed 7 to 27 glasses/week, and 26.8% consumed 28 or more glasses/week.

To avoid liver events and death, patients with compensated alcohol-related cirrhosis should be advised to completely discontinue alcohol intake, even small amounts.

Among those who were alcohol abstinent at baseline, 18.3% had a recurrence at 24 months and 30.9% had a recurrence at 60 months.

In the multivariate model, alcohol relapse was associated with substance use disorder (subdistribution hazard ratio [sHR], 2.06; 95% CI, 1.06-3.99; P =.033) and years since alcohol weaning (sHR, 0.93; 95% CI, 0.86-0.99; P =.042).

During follow-up, 97 participants had a liver decompensation event, 61 developed hepatic cellular carcinoma (HCC), 3 received a liver transplant, and 156 died. Deaths occurred due to cirrhosis (n=64), HCC (n=18), non-HCC malignancy (n=26), cardiovascular causes (n=15), other causes (n=17), or unknown causes (n=13). The median liver event-free survival was 82.9 months, and survival was 97 months.

Complication-free survival was less likely among participants with Child-Pugh a score greater than A5 (hazard ratio [HR], 1.92; 95% CI, 1.38-2.68; P =.00012), 1 to 6 (HR, 1.83; 95% CI, 1.19-2.81; P =.027) and at least 28 (HR, 1.67; 95% CI, 1.02-2.76; P =.020) glasses/week consumption compared with abstinence and age per 10 years (HR, 1.20; 95% CI, 1.02-1.41; P =.030).

Decreased survival risk was associated with a Child-Pugh score greater than A5 (HR, 2.11; 95% CI, 1.44-3.10; P =.0001), 1 to 6 (HR, 1.76; 95% CI, 1.07-2.90; P =.027) and 28 or more (HR, 1.34; 95% CI, 1.11-3.38; P =.020) glasses/week compared with abstinence, glasses-years greater than 25 (HR, 1.50; 95% CI, 1.02-2.22; P =.041), age per 10 years (HR, 1.27; 95% CI, 1.05-1.54; P =.013), and creatinine per 10 mmol/L (HR, 1.03; 95% CI, 1.003-1.07; P =.034).

The major limitation of this study was the possibility that some patients underreported their alcohol consumption.

Study authors conclude, “To avoid liver events and death, patients with compensated alcohol-related cirrhosis should be advised to completely discontinue alcohol intake, even small amounts.”

This article originally appeared on Gastroenterology Advisor


Louvet A, Bourcier V, Archambeaud I, et al. Low alcohol consumption influences outcomes in individuals with alcohol-related compensated cirrhosis in a French multicenter cohort. J Hepatol. 2022;S0168-8278(22)03304-9. doi:10.1016/j.jhep.2022.11.013