Introduction Alcoholic liver disease (ALD) is a significant and increasing threat to the health of the British population. It remains one of the commonest indications for liver transplantation and a leading cause of death. Despite this, the long term clinical course and predictive factors of survival in advanced ALD have not been well described. We aimed to identify factors that predict 15-year survival in out-patients with biopsy-proven advanced ALD.
Methods Patients attending clinic in our institution during early 1996 (n=134) with biopsy proven advanced (stage III or IV) ALD were followed-up for 15 years or until death or transplantation. At baseline, clinical data including alcohol and smoking history, BMI and features of portal hypertension were recorded. Laboratory data (bilirubin, creatinine, sodium, PT, INR and platelet count) were collected. On biopsy, the presence of cirrhosis and histological features (fat severity, lymphocyte and neutrophil infiltration) were scored semi-quantitatively.
Results Median age was 51 (29–67) and the majority (72%) were male. All patients had a history of alcohol excess (>80 g/day for men, 50 g/d for women). Patients were followed until death (n=97; median 62 m), OLT (n=5; median 96 m) or are still alive (n=32; median 187 m). Overall, the 5, 10 and 15-year survival was 64, 40 and 26%, respectively. Patient baseline characteristics are shown according to outcome (Abstract PWE-285 table 1). In multivariate analysis age (p=0.01), smoking (p=0.01), persistent drinking (p<0.01) and serum albumin at baseline (p=0.02) were associated with significantly increased risk of death. No histological features correlated with prognosis.
Conclusion In out-patients with biopsy-proven advanced ALD, clinical but not histological factors determine prognosis. Age, persistent alcohol intake, smoking habit and serum albumin are independent poor prognostic factors. Abstinence from alcohol and smoking cessation should be the priorities in the long-term management of ALD.
Competing interests None declared.