Prospective evaluation of alcohol abuse and alcoholic liver injury in men as predictors of development of cirrhosis.

258 alcohol-abusing men, free from cirrhosis on primary liver biopsy, were followed for 10-13 years during which cirrhosis developed in 38, corresponding to a rate of 2% per year. The likelihood of cirrhosis developing proved to be independent of duration of abuse and of daily consumption before the primary biopsy. This indicates that the effect of alcohol abuse is not cumulative over time, but rather establishes conditions for the development of cirrhosis. The rate of cirrhosis increased stepwise with degree of steatosis in the primary biopsy, and in those with alcoholic hepatitis was nine times higher than in those with no steatosis. This finding, together with the results on alcohol abuse, indicates that steatosis and alcoholic hepatitis, despite their reversibility, are causally associated with cirrhosis rather than epiphenomena of alcohol abuse. In the alcohol-abusing man, a liver biopsy provides more information than alcoholic history about the likelihood of future cirrhosis.