There is growing evidence regarding increased incidence of alcohol-related liver disease India with late presentation and short survival. Better identification of factors affecting mortality is warranted for better utilization of constrained resources like liver transplantation.

The study included baseline data of 395 patients with alcohol-related liver disease including age, clinical presentation, alcohol parameters (amount, duration, type), laboratory parameters for detecting organ failure. The prognostic scores were contrasted between survivor and deceased groups. Additional subgroup analysis of deceased patients was done to recognise factors correlated with early mortality in acute-on-chronic liver failure (ACLF) and cirrhosis groups by multivariate analysis and receiver operating characteristic (ROC) curves. All patients were given the best supportive medical therapy.

The outcome suggested that 80 (20.3%) patients had alcoholic hepatitis (without cirrhosis) and all of them were recovered completely with abstinence. A total of 315 (79.7%) had evidence of either cirrhosis (n = 182, 46.1%) or ACLF (n = 133, 33.6%) at presentation and all of them died within the next 2 years of follow-up, earlier in the ACLF cases. All deceased patients were heavy drinkers for long duration (>85 g/day for >17 years). Severity of disease and early mortality were predicted by higher age, amount of alcohol consumption, number of organ failures and discriminant function score predicted. The European Foundation for the study of chronic liver failure consortium (CLIF-C) score has good applicability in Indian ACLF cohorts. Normal concentration of serum glutamic pyruvic transaminase was seen in 73.8% of deceased patients in contrast to only 12.5% of survivors. However, complete normalization of elevated laboratory parameters was not achieved by abstinence in patients who died.

The trial thus, concluded that alcohol-related liver disease exhibits severe consequences with high short-term mortality. Although it has early identifiable, has typically irreversible factors. Moreover, urgent methods are required to be taken to stop this rising epidemic.

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 Aug;4(3):104-114.