Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Oct;43(10):2220-2231.
doi: 10.1111/liv.15676. Epub 2023 Jul 20.

Hepatic recompensation according to Baveno VII criteria is linked to a significant survival benefit in decompensated alcohol-related cirrhosis

Benedikt Silvester Hofer  1   2   3 , Benedikt Simbrunner  1   2   3 , Lukas Hartl  1   2 , Mathias Jachs  1   2 , Lorenz Balcar  1   2 , Rafael Paternostro  1   2 , Philipp Schwabl  1   2   3 , Georg Semmler  1   2 , Bernhard Scheiner  1   2 , Michael Trauner  1 , Mattias Mandorfer  1   2 , Thomas Reiberger  1   2   3
Affiliations

Hepatic recompensation according to Baveno VII criteria is linked to a significant survival benefit in decompensated alcohol-related cirrhosis

Benedikt Silvester Hofer et al. Liver Int. 2023 Oct.

Abstract

Background & aims: Removing the primary aetiological factor in decompensated cirrhosis may lead to a restoration of hepatic function. In this study, we investigated the clinical implications of recompensation and the subsequent survival in patients with decompensated alcohol-related cirrhosis.

Methods: The rate of recompensation was evaluated in patients with decompensated alcohol-related cirrhosis and persistent alcohol abstinence undergoing a hepatic venous pressure gradient (HVPG) measurement. Recompensation was defined according to Baveno VII criteria as resolution of ascites and hepatic encephalopathy, absence of variceal bleeding and improvement in liver function.

Results: Two hundred and four abstinent patients with decompensated alcohol-related cirrhosis (age: 57.2 [IQR:50.1-63.7] years; 75.0% male; median MELD: 15 [IQR:11-19]) and a median HVPG of 20 (IQR:18-24) mmHg were included. During a median follow-up of 24.4 (IQR:10.9-50.4) months, 37 patients (18.1%) achieved abstinence-induced recompensation. Lower baseline HVPG, lower Child-Pugh score, lower BMI, higher albumin and higher mean arterial pressure were linked to a higher probability of recompensation. After adjusting for age, disease severity, portal hypertension and systemic inflammation, achieving recompensation resulted in a significant and considerable reduction in liver-related mortality (adjusted HR: 0.091 [95% CI: 0.012-0.677]; p = .019). Only 13 patients (6.4%) developed hepatocellular carcinoma, with a tendency towards a lower risk upon recompensation (HR: 0.398 [95% CI: 0.084-1.878]; p = .245), yet this finding did not reach statistical significance and requires further investigation.

Conclusions: Alcohol abstinence led to recompensation in 18.1% of our cohort of HVPG-characterised patients with decompensated alcohol-related cirrhosis. Achieving hepatic recompensation resulted in a >90% risk reduction in liver-related mortality.

Trial registration: ClinicalTrials.gov NCT03267615.

Keywords: advanced chronic liver disease; alcohol-related liver disease; hepatic venous pressure gradient; hepatocellular carcinoma; portal hypertension.

PubMed Disclaimer

Comment in

References

REFERENCES

    1. Rehm J, Samokhvalov AV, Shield KD. Global burden of alcoholic liver diseases. J Hepatol. 2013;59:160-168.
    1. Blachier M, Leleu H, Peck-Radosavljevic M, Valla DC, Roudot-Thoraval F. The burden of liver disease in Europe: a review of available epidemiological data. J Hepatol. 2013;58:593-608.
    1. Parker R, Aithal GP, Becker U, et al. Natural history of histologically proven alcohol-related liver disease: a systematic review. J Hepatol. 2019;71:586-593.
    1. Jepsen P, Ott P, Andersen PK, Sørensen HT, Vilstrup H. Clinical course of alcoholic liver cirrhosis: a Danish population-based cohort study. Hepatology. 2010;51:1675-1682.
    1. D'Amico G, Morabito A, D'Amico M, et al. Clinical states of cirrhosis and competing risks. J Hepatol. 2018;68:563-576.

Publication types

Associated data