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Alcohol-related liver disease phenotype impacts survival after an acute variceal bleeding episode |
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Liver Int. 2023 Jul;43(7):1548-1557. doi: 10.1111/liv.15606.Epub 2023 May 15.
Ares Villagrasa 1, Virginia Hernández-Gea 2 3, Ramon Bataller 3 4, Álvaro Giráldez 5, Bogdan Procopet 6, Lucio Amitrano 7, Candid Villanueva 2 8, Dominique Thabut 9 10, Luis Ibañez-Samaniego 2 11, Agustin Albillos 2 12, Christophe Bureau 13, Jonel Trebicka 14, Elba Llop 2 15, Wim Laleman 16, J M Palazon 17, Jose Castellote 18, Susana Rodrigues 19, Lise L Gluud 20, Carlos N Ferreira 21, Nuria Cañete 22, Manuel Rodríguez 23, Arnulf Ferlitsch 24, Jose L Mundi 25, Henning Gronbaek 26, Manuel Hernández-Guerra 27, Romano Sassatelli 28, Alessandra Dell'Era 29, Marco Senzolo 30, Juan G Abraldes 31, Alexander Zipprich 32, Meritxell Casas 33, Helena Masnou 34, Massimo Primignani 35, Aleksander Krag 36, Gilberto Silva-Junior 3, Manuel Romero-Gómez 5, Marcel Tantau 6, Maria A Guardascione 7, Edilmar Alvarado 2 8, Marika Rudler 9 10, Rafael Bañares 2 11, Javier Martinez 12, Marie A Robic 13, Christian Jansen 14, Jose L Calleja 2 15, Frederik Nevens 16, Jaime Bosch 2 3 37, Meritxell Ventura-Cots 1 2, Juan C García-Pagan 2 3, Joan Genescà 1 2; International Variceal Bleeding Observational Study Group; Baveno Cooperation
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Author information
- 1Liver Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain.
- 2Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain.
- 3Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, IMDIM, University of Barcelona, Barcelona, Spain.
- 4Center for Liver Diseases, Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
- 5UCM Digestive Diseases and CIBEREHD, University Hospital Virgen del Rocío, Institute of Biomedicine of Seville (CSIC/HUVR/US), University of Seville.
- 6Regional Institute of Gastroenterology and Hepatology "Octavian Fodor", Hepatology Department and "Iuliu Hatieganu", University of Medicine and Pharmacy, 3rd Medical Clinic, Cluj-Napoca, Romania.
- 7Gastroenterology Unit, Ospedale A Cardarelli, Naples, Italy.
- 8Department of Gastroenterology, Hospital of Santa Creu and Sant Pau, Universitat Autònoma de Barcelona, Hospital Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain.
- 9Sorbonne Université, AP-HP. Sorbonne Université, Hôpital de la Pitié-Salpêtrière, service d'hépato-gastroentérologie, Paris, France.
- 10Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, INSERM UMR_S 938, Centre de recherche Saint-Antoine, Maladies métaboliques, biliaires et fibro-inflammatoire du foie, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France.
- 11Servicio de Medicina de Aparato Digestivo Gregorio Marañón, Hospital General Universitario Gregorio Marañón, liSGM, Madrid, Spain.
- 12Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain.
- 13Department of Hepato-Gastroenterology, Purpan Hospital, CHU Toulouse; INSERM U858, University of Toulouse, Toulouse, France.
- 14Department of Internal Medicine I, University of Bonn, Bonn, Germany.
- 15Liver Unit, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, Spain.
- 16Department of Gastroenterology and Hepatology, University of Leuven, KU Leuven, Leuven, Belgium.
- 17ISABIAL, Hospital General y Universitario de Alicante, Dr. Balmis, Alicante, Spain.
- 18Gastroenterology Department, Hepatology Unit, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, Spain.
- 19Gastroenterology and Hepatology Department, Centro Hospitalar São João, Porto, Portugal.
- 20Gastrounit, Medical Division, University Hospital of Hvidovre, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- 21Serviço de Gastroenterologia e Hepatologia, Hospital de Santa Maria-Centro Hospitalar, Lisbon Norte, Portugal.
- 22Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
- 23Department of Gastroenterology, Hospital Central de Asturias, Oviedo, Spain.
- 24Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.
- 25Department of Gastroenterology, University Hospital San Cecilio, Granada, Spain.
- 26Department of Hepatology and Gastroenterology, Aarhus University Hospital & Clinical Institute, Aarhus University, Aarhus, Denmark.
- 27Gastroenterology Department, University Hospital of the Canary Islands, La Laguna, Spain.
- 28Unit of Gastroenterology and Digestive Endoscopy, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
- 29Gastroenterology Unit, ASST Fatebenefratelli Sacco, Department of Clinical and Biomedical Sciences, University of the Studies of Milan, Milan, Italy.
- 30Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padua, Italy.
- 31Cirrhosis Care Clinic, Division of Gastroenterology (Liver Unit), CEGIIR, University of Alberta, Edmonton, Canada.
- 32Clinic for Internal Medicine IV, University Hospital Jena, Düsseldorf, Germany.
- 33Liver Unit, Gastroenterology Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, Spain.
- 34Hospital Universitari Germans Trias i Pujol, Universitat Autònoma Barcelona, Badalona, Spain.
- 35Division of Gastroenterology and Hepatology, IRCCS Ca' Granda Maggiore Hospital Foundation, University of Milan, Italy.
- 36Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark.
- 37Visceral Surgery and Medicine, Inselspital, Hospital of Bern University CH, Bern, Switzerland.
Abstract
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.
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