Recompensation Following Alcohol-Related Hepatitis Is Associated With Increased Survival: Results From a Multicenter Study

Abstract

Background & aims: The rate of recompensation following alcohol-related hepatitis is unknown. The aims of this study were to assess the rate, predictors, and clinical impact of recompensation in survivors of alcohol-related hepatitis, and to develop adapted recompensation criteria.

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; P_log-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.

Keywords: Abstinence; Alcohol-Associated; Cirrhosis; Decompensation; Survival.