Article Text


Early resolution of systemic inflammation mirrors improvement in meld score and predicts survival after first presentation of alcoholic liver disease
  1. R Parker *1,2
  1. 1Gastroenterology, Sandwell and West Birmingham Hospitals, Birmingham, UK
  2. 2Centre for Liver Research, University of Birmingham, Birmingham, UK


Introduction Alcoholic Liver Disease (ALD) is a spectrum of disease, from steatosis to cirrhosis. Despite years of research it is still unclear why some patients will not progress while others develop cirrhosis and associated morbidity and mortality. The authors investigated markers of inflammation (C reactive protein, CRP) and survival after first presentation of ALD.

Methods Patients presenting with ALD between 1999 and 2002 were identified retrospectively from clinical coding. Records were reviewed to exclude patients with prior episodes of ALD and viral, autoimmune, or metabolic liver disease. CRP was noted as a measure of systemic inflammation at presentation, 6 months and yearly intervals to 5 years. Cause of death after presentation was recorded and categorised as liver-related or non-liver related.

Results 95 patients were included; 60 survived or died (6) of non-liver related causes, 35 died of liver disease. Groups did not differ at baseline significantly with respect to median age (48 vs 50), discriminant function (20 vs 24) or MELD score (10.7 vs 13.7) in survivors (S) and non-survivors (NS) respectively. Changes in CRP over time are shown in table 1. At 12 months there was a significant difference between groups, mirrored in the MELD score at 12 months. Beyond 12 months there was no significant difference in CRP or MELD score. Fall in CRP (defined as greater than 50%) had sensitivity of 100% and 80% at 6 and 12 months respectively in predicting survival, although this was only possible in small numbers of patients.

Table 1


Conclusion This retrospective data set has limitations but confirms that persistent inflammation in ALD relates to mortality. Medical treatment of ALD has not progressed in over 25 years despite multiple trials of novel anti-inflammatory agents. Further research is needed to define and modify the inflammatory process in ALD.

  • alcoholic liver disease

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  • Competing interests None.

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