Alcohol

Liver disease

Interquartile range

Cirrhosis

Portal venous pressure

Psychiatry

Biochemistry

Portal hypertension

Alcoholic liver disease

Decompensation

Internal medicine

Confidence interval

Hazard ratio

Medicine

Chemistry

Abstinence

Gastroenterology

Clinical Gastroenterology and Hepatology

Background and Aims Alcohol-related liver disease (ALD) is a leading cause of liver-related mortality. The effect of alcohol abstinence on the natural history of alcohol-related cirrhosis across distinct stages of portal hypertension has not been thoroughly investigated. In this study we assessed the clinical implications of abstinence in patients with alcohol-related cirrhosis and clinically significant portal hypertension (CSPH). Methods Alcohol abstinence, hepatic decompensation and mortality were assessed in patients with alcohol-related cirrhosis who underwent a baseline hepatic venous pressure gradient (HVPG) measurement and were diagnosed with CSPH (HVPG ≥10 mmHg). Results 320 patients with alcohol-related cirrhosis (median age: 57 [IQR:13.4] years; 75.6% male; 87.5% decompensated) and a median HVPG of 20 (IQR:6) mmHg were followed up for a median of 36 (IQR:66) months. Overall, 241 patients (75.3%) remained abstinent, while 79 patients (24.7%) had active alcohol consumption. Alcohol abstinence was linked to a significantly reduced risk of hepatic decompensation (aHR:0.391; p<0.001), as well as liver-related (aHR:0.428; p<0.001) and all-cause mortality (aHR:0.453; p<0.001), after adjusting for baseline HVPG, MELD and previous decompensation. Importantly, alcohol abstinence significantly reduced the cumulative incidence of hepatic decompensation in both groups with HVPG 10-19 mmHg (p<0.001) and HVPG ≥20 mmHg (p=0.002). The 3-year decompensation probability was 32.4% vs. 60.0% in HVPG 10-19 mmHg and 57.5% vs. 82.6% in HVPG ≥20 mmHg for abstinent patients vs. active drinkers, respectively. Conclusions Alcohol abstinence improves prognosis across all stages of portal hypertension in alcohol-related cirrhosis, including in patients who have already progressed to high-risk portal hypertension.

Alcohol Abstinence Improves Prognosis Across All Stages of Portal Hypertension in Alcohol-Related Cirrhosis