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Cited by 80Alcohol Consumption and Health EffectsLiver Disease and TransplantationSubstance Abuse Treatment and Outcomes

Low alcohol consumption influences outcomes in individuals with alcohol-related compensated cirrhosis in a French multicenter cohort

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Louvet, Alexandre, Bourcier, Valérie, Archambeaud, Isabelle, d’Alteroche, Louis, Chaffaut, Cendrine, Oberti, Frédéric, Moreno, Christophe, Roulot, Dominique +40 more·2023·Journal of Hepatology
DOI 10.1016/j.jhep.2022.11.013
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Abstract

Background & aims The harmful impact of heavy alcohol consumption and recurrence in patients with alcohol-related cirrhosis is long-established, although this is based on old studies. However, the drivers of long-term outcome still need to be clearly investigated.Method All patients with biopsy-proven compensated alcohol-related cirrhosis included in the CIRRAL cohort (22 centers) were prospectively studied. Prognostic variables of survival and liver event-free survival were assessed using multivariable Cox models with stepwise selection. The prognostic impact of alcohol recurrence during follow-up (computed in glass-years in the same way as pack-years for tobacco) was assessed using a time-dependent covariable.Results From 2010 to 2016, 650 patients were included. The median age at baseline was 58.4 years, 67.4% were men and the median BMI was 27.8 kg/m 2, 63.8% had a history of liver decompensation, and 70.2% had discontinued alcohol. At 5 years, recurrence occurred in 30.9% of abstinent patients and this risk was higher in patients with a history of drug abuse and in those with shorter alcohol discontinuation times. Median survival was 97 months. Age, alcohol consumption at baseline, platelet count and Child-Pugh score >5 were associated with overall and liver event-free survival on multivariate analysis. Alcohol consumption of more than 25 glass-years during follow-up was independently associated with lower survival and with a trend toward lower liver event-free survival, with the risk increasing from 1 glass-year, though not significantly. Simon & Makuch plots confirm the benefit of no alcohol consumption (<1 glass/week) on both outcomes and the dose-dependent impact of alcohol over time.Conclusion This prospective study in patients with compensated alcohol-related cirrhosis identifies factors predictive of alcohol recurrence during follow-up and shows that moderate alcohol consumption during follow-up negatively impacts outcomes. Patients with alcohol-related cirrhosis should be advised to completely stop drinking alcohol.Registration CIRRAL (NCT01213927) cohort was registered at ClinicalTrials.gov and the full protocol is available at the following link: https://clinicaltrials.gov/ct2/show/NCT01213927.Impact and implications In patients with alcohol-related cirrhosis, data are lacking about the impact of the amount of alcohol consumed on both survival and liver-related events. The present study based on the CIRRAL cohort demonstrates that alcohol recurrence occurs in more than 30% of patients with compensated cirrhosis and that even a moderate recurrence strongly influences outcomes. Patients with compensated alcohol-related cirrhosis should be advised to completely discontinue alcohol consumption, even in small amounts, as the present study shows that no alcohol consumption can be regarded as safe when cirrhosis has developed.

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  • In a large series of individuals with alcohol-related cirrhosis, even comparatively low levels of consumption (1-6 glasses per week) were associated with reduced overall survival and increased occurrence of hepatic decompensation.

    “In a large series of individuals with alcohol-related cirrhosis, even comparatively low levels of consumption (1-6 glasses per week) were associated with reduced overall survival and increased occurrence of hepatic decompensation, thus supporting total abstinence in individuals with compensated cirrhosis.”

    From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [100]

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Authors
Louvet, A., Bourcier, V., Archambeaud, I., d’Alteroche, L., Chaffaut, C., Oberti, F., Moreno, C., Roulot, D., Dao, T., Moirand, R., Duclos-Vallée, J.-C., Goria, O., Nguyen-Khac, E., Pol, S., Carbonell, N., Gournay, J., Elkrief, L., Fouchard-Hubert, I., Chevret, S., Ganne-Carrié, N., Ganne-Carrié, N., Bourcier, V., Chaffaut, C., Chevret, S., Archambeaud, I., Gournay, J., d’Alteroche, L., Elkrief, L., Oberti, F., Fouchard-Hubert, I., Roulot, D., Moreno, C., Louvet, A., Dao, T., Moirand, R., Duclos-Vallée, J.-C., Goria, O., Nguyen-Khac, E., Pol, S., Carbonell, N., Péron, J.-M., de Lédinghen, V., Ozenne, V., Henrion, J., Tran, A., Perlemuter, G., Amiot, X., & Zarski, J.-P.
Affiliations
Hôpital Paul-Brousse (FR)
ORCID
Venue
Journal of Hepatology
Publisher
Elsevier BV
Published
2023-03
Volume
78
Issue
3
Pages
501-512
ISSN
0168-8278 (ISSN-L)
DOI
10.1016/j.jhep.2022.11.013
OpenAlex
W4309765528
Cited by
80
References
34
Citations by year
2026: 14 · 2025: 21 · 2024: 28 · 2023: 17
FWCI
11.19
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Hepatology (acceptedVersion)
  • PubMed (publishedVersion)
  • HAL (submittedVersion)
  • HAL (submittedVersion, cc-by-nc)
Funders
  • ANRS
  • INCa
Topics
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
  • Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords
alcohol consumption, alcohol abstinence, survival, prognostic factors, hepatic decompensation, drug abuse, Child-Pugh score, platelet count, alcoholic liver disease, liver transplantation eligibility, liver transplantation outcomes
MeSH terms
Ethanol, Female, Humans, Liver Cirrhosis, Liver Cirrhosis, Alcoholic, Liver Neoplasms, Male, Prospective Studies

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