DECOMPENSATION occurred in nearly 15% of patients with alcoholic-related liver disease, 22% of whom died within 6 years, according to a study presented at the European Association for the Study of the Liver (EASL) Congress 2023. While this condition is highly prevalent, as a research area it remains understudied and overlooked, explained author Stine Johansen, Odense University Hospital, Denmark, which is why their team conducted a prospective study to investigate the clinical course of biopsy-controlled, alcohol-related liver disease.
The study included 458 patients, 57% of whom were Stage F0–1, 23% F2, and 20% F3–4. All participants had a history of excessive alcohol consumption (median 15.5 years) without prior decompensation. Liver biopsies, blood tests, and transient elastography measurements were obtained at baseline, and four single nucleotide polymorphisms were genotyped using blood tests: PNPLA3, MBOAT7, TM6SF2, and HD17B13. Median follow-up was of 5.9 years, during which the team analysed medical health records for new diagnoses, hospitalisations, or complications; and reports of alcohol consumption and all-cause mortality.
In total, 67 patients reported first decompensation, including variceal bleeding, overt ascites, and hepatic encephalopathy. Furthermore, 46 (10%) also reported at least one additional decompensation, and 101 (22%) died, including 38% from hepatic cause, 42% from non-hepatic cause, and 20% from unknown cause. Of those who died, 22% had cirrhosis. Researchers also noted an increase in all-cause mortality as fibrosis stage increased from 1.4 deaths per 100 person-years for Stage F0–1, to 5.0 for Stage F2, and 9.3 for Stage F3–4. They identified excessive drinking and baseline fibrosis stage as independent predictors of a first decompensation; however, PNPLA and TM6SF2 did not have independent prognostic information.
Johansen concluded that “for patients with alcohol-related liver disease in earlier stages, we see a high progression rate,” where “15% progressed to decompensation,” and that mortality rates are high, with fibrosis stage and alcohol intake being the strongest predictors of events.
