Introduction Whilst early management and outcome of decompensated ALD has been extensively studied, there are few published data on long-term outcome. We have previously (McFarlane, Gut 2006; 55:A2 and 55:A36) reported on early and 4-yr mortality in 249 patients (163 men, age (mean(range)) 50(27–77) yr) admitted consecutively to our unit between 1/4/1998 and 31/12/2005 with first presentation of decompensated ALD (Child grade B or C).Here we aimed to assess long-term mortality and its associations in this cohort.
Methods We reviewed available hospital records, and death certificates and contacted surviving patients and general practitioners to assess who had died, the causes of death and the patients’ overall alcohol drinking behaviour subsequent to the index hospital episode (classified as: abstinent, continued drinking but reduced, and did not reduce).
Results 37 patients died during the index hospital episode, all because of liver disease. The other 212 patients (including one transplanted during the index episode) were followed up for 4.3 (0.03–13.0) years. Only one other patient was transplanted. 154 patients have subsequently died. Cause of death is known in 134 (87%) and was due to liver disease in 95 (71%) of these. Only 4 patients died of hepatocellular carcinoma. Overall 5- and 10- year total mortality rates were 52+(SEM)4% and 75+3% respectively; corresponding rates from causes known to be liver related were 41+5% and 51+4%. Patients who were abstinent (n = 52) had lower total and known liver-related mortality (61+9% and 20+6% after 10 yr) compared to those who continued but reduced (n = 105; 73+5% p = 0.122 and 53+6% p = 0.013) and to those who did not reduce (n = 53; 91+4% p < 0.001 and 71+7% p < 0.001). In Cox regression analysis, both total and known liver-related mortality were independent of age, gender and severity of liver dysfunction at index presentation (Child, MELD, Glasgow and Maddrey scores) but were strongly associated with subsequent drinking behaviour (both p < 0.001) and inversely associated with serum albumin at discharge following index hospital episode (p = 0.001 and 0.019).
Conclusion Patients with decompensated ALD who survive their first hospital episode have high long-term mortality, mainly due to liver disease, which is reduced but not prevented by abstinence.
Disclosure of Interest None Declared
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