Determinants of long-term outcome in severe alcoholic hepatitis

Background Although short-term outcome in severe alcoholic hepatitis (SAH) is well described, its long-term course remains uncharacterised. Aim To assess determinants of long-term outcome in SAH. Methods Data were recorded from a cohort with SAH (admission Discriminant Function (DF) 32). Kaplan-Meier (KM) and Cox proportional hazards survival analyses were performed to determine predictors of outcome. Results One hundred and nine patients were included; 63.3% male, aged 49.6 +/- 9.4years with median follow-up of 40.7months (95% CI 37.2-44.3). Median DF was 58, 86.2% had cirrhosis and 65.1% received corticosteroids and/or pentoxifylline. Overall mortality was 57.8%, 96.8% of deaths being liver-related and 65.1% occurring after the index hospitalisation. Estimated 5-year survival was 31.8%. Hepatorenal syndrome was the only baseline factor independently associated with mortality (HR 3.78, 95% CI 1.98-7.19, P<0.0001), although it predicted short-term, rather than long-term outcome (median survival 0.52months, 95% CI 0.43-0.61). Of the 87 patients (79.8%) who survived index hospitalisation, 65.1% experienced recidivism. Abstinence at last follow-up remained the only independent predictor of survival in multivariate analysis (HR 0.370, 95% CI 0.168-0.818, P=0.014). Five-year survival was higher in abstainers (75.3%) compared with relapsed and continued drinkers (26.8% and 21.0%, respectively, P=0.005). However, the survival benefit from abstinence only became statistically significant at 18months postdischarge (HR 2.714, 95% CI 0.995-7.404, P=0.051). Conclusions Estimated 5-year survival after index hospitalisation with SAH is 31.8% with alcohol relapse occurring in two-thirds of patients. Abstinence remains the only independent predictor of long-term survival. Novel strategies to improve abstinence after admission with SAH are urgently needed.