Recompensation Following Alcohol-Related Hepatitis Is Associated With Increased Survival: Results From a Multicenter Study.
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Gratacós-Ginès Jordi, Ruz-Zafra Pilar, Herms Queralt, Celada-Sendino Miriam, Villagrasa Ares, Cáceres Federico, Martín-Mateos Rosa, Echavarría Víctor, Sánchez Jordi, García Sonia, Barreales Mónica, Tejedor-Tejada Javier, Vázquez-Rodríguez Sergio, Cañete Nuria, Fernández-Carrillo Carlos, Valenzuela María, Marti-Aguado David, Horta Diana, Quiñones Marta, Bernal-Monterde Vanesa, Acosta Silvia, Artaza Tomás, Pinazo José, Villar-Lucas Carmen, Prieto De la Torre María, Clemente-Sánchez Ana, Badia-Aranda Ester, Alventosa-Mateu Carlos, Giráldez-Gallego Álvaro, Rivera-Esteban Jesús, Solís-Muñoz Pablo, Alvarado-Tapias Edilmar, Cabezas Joaquín, Ventura-Cots Meritxell, Fernández-Rodríguez Conrado, Rodríguez Manuel, Aguilera Victoria, Tomé Santiago, Caballería Juan, Bataller Ramon, Pose Elisa, REHALC Registry Investigators
Аннотация
METHODS: Nationwide registry-based study including patients with alcohol-related hepatitis who were discharged between 2014 and 2021. Recompensation was defined according to: (1) Baveno VII criteria; or (2) expanded criteria for alcohol-related hepatitis in which alcohol abstinence was not required (alcohol-related hepatitis liberal-abstinence criteria); and was assessed at 1 and 3 years. A landmark analysis was used to evaluate the impact of recompensation on transplant-free survival.
RESULTS: A total of 577 patients (85% with cirrhosis) were included. The rate of recompensation at 1 and 3 years was 9.9% and 8.8% (Baveno VII), and 11.4% and 14.3% (alcohol-related hepatitis liberal-abstinence). In patients with cirrhosis, rates were 8.2% and 9.0% at 1 and 3 years (Baveno VII). The absence of decompensation prior to alcohol-related hepatitis, higher baseline alkaline phosphatase levels and lower Child-Pugh score were independently associated with recompensation. In patients abstinent from alcohol at 1 year, the rate of recompensation at 1 and 3 years was 26.5% and 25.8%, respectively. Patients with recompensated disease had higher estimated 5-year transplant-free survival (84.9% vs 47.7% in decompensated disease; Plog-rank < .001). Survival estimates did not differ when classifying patients according to alcohol-related hepatitis liberal-abstinence criteria. Recompensation after alcohol-related hepatitis was a predictor of long-term survival.
CONCLUSIONS: Recompensation in alcohol-related hepatitis is common, particularly following abstinence, and is associated with increased survival. Predicting recompensation in alcohol-related hepatitis can be valuable in decision-making, including the evaluation for liver transplantation.