The incidence of alcohol-related liver disease has shown a startling increase in India with late presentation and short survival. There is a need for better understanding of factors affecting mortality for optimal utilization of the already strained resources such as liver transplantation. A study was conducted with 395 Indian patients with alcohol-related liver disease. Baseline data were compared for survivors and deceased. This included age, clinical presentation, alcohol parameters (amount, duration, type), laboratory parameters to detect organ failure, and prognostic scores. Subgroup analysis of deceased patients was also conducted to determine the factors associated with early mortality in acute-on-chronic liver failure (ACLF) and cirrhosis patients using multivariate analysis and receiver operating characteristic (ROC) curves.

About 20.3% patients had alcoholic hepatitis (without cirrhosis) and showed complete recovery with abstinence. Nearly 79.7% had evidence of either cirrhosis (46.1%) or ACLF (33.6%) at presentation and all succumbed within the next 2 years of follow-up. Mortality was earlier in ACLF cases. All deceased patients had been heavy drinkers for long periods of time (>85 g/day for >17 years). Higher age, amount of alcohol consumption, number of organ failures and discriminant function score were predictors of severe disease and early mortality, with the latter being the best predictor.

The European Foundation for the study of chronic liver failure consortium (CLIF-C) score has been found to have good applicability in Indian ACLF patients. Serum glutamic pyruvic transaminase level was found normal in 73.8% of deceased patients compared to 12.5% of survivors. Abstinence did not lead to complete normalization of altered laboratory parameters in those who died.

It was concluded that alcohol-related liver disease is associated with high short-term mortality, and has early identifiable and mostly irreversible factors.

Source: Ray G, Manjubhargav P. Clinical Presentation and Mortality Determinants of Alcohol-Related Liver Disease: A Single-Center Experience of the Rising Menace from Eastern India. Inflamm Intest Dis 2019;4:104–114.