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Multicenter Study
. 2024 Sep 1;80(3):621-632.
doi: 10.1097/HEP.0000000000000825. Epub 2024 Mar 5.

Recurrent alcohol-associated hepatitis is common and is associated with increased mortality

Jordi Gratacós-Ginès  1   2   3 , Pilar Ruz-Zafra  4 , Miriam Celada-Sendino  5 , Aina Martí-Carretero  6 , Clàudia Pujol  7 , Rosa Martín-Mateos  8 , Víctor Echavarría  9 , Luis E Frisancho  10 , Sonia García  11 , Mónica Barreales  12 , Javier Tejedor-Tejada  13 , Sergio Vázquez-Rodríguez  14 , Nuria Cañete  15 , Carlos Fernández-Carrillo  16 , María Valenzuela  17 , David Martí-Aguado  18 , Diana Horta  19 , Marta Quiñones  20 , Vanesa Bernal-Monterde  21 , Silvia Acosta  22 , Tomás Artaza  23 , José Pinazo  24 , Carmen Villar-Lucas  25 , Ana Clemente-Sánchez  26 , Ester Badia-Aranda  27 , Álvaro Giráldez-Gallego  4 , Manuel Rodríguez  5 , Pau Sancho-Bru  2 , Joaquín Cabezas  9 , Meritxell Ventura-Cots  3   6 , Conrado Fernández-Rodríguez  20   28 , Victoria Aguilera  3   11 , Santiago Tomé  29 , Ramon Bataller  1   3 , Juan Caballería  1   2   3 , Elisa Pose  1   2   3 ; REHALC Registry investigators
Collaborators, Affiliations
Free article
Multicenter Study

Recurrent alcohol-associated hepatitis is common and is associated with increased mortality

Jordi Gratacós-Ginès et al. Hepatology. .
Free article

Abstract

Background and aims: Alcohol relapse after surviving an episode of alcohol-associated hepatitis (AH) is common. However, the clinical features, risk factors, and prognostic implications of recurrent alcohol-associated hepatitis (RAH) are not well described.

Approach and results: A registry-based study was done of patients admitted to 28 Spanish hospitals for an episode of AH between 2014 and 2021. Baseline demographics and laboratory variables were collected. Risk factors for RAH were investigated using Cox regression analysis. We analyzed the severity of the index episodes of AH and compared it to that of RAH. Long-term survival was assessed by Kaplan-Meier curves and log-rank tests. A total of 1118 patients were included in the analysis, 125 (11%) of whom developed RAH during follow-up (median: 17 [7-36] months). The incidence of RAH in patients resuming alcohol use was 22%. The median time to recurrence was 14 (8-29) months. Patients with RAH had more psychiatric comorbidities. Risk factors for developing RAH included age <50 years, alcohol use >10 U/d, and history of liver decompensation. RAH was clinically more severe compared to the first AH (higher MELD, more frequent ACLF, and HE). Moreover, alcohol abstinence during follow-up was less common after RAH (18% vs. 45%, p <0.001). Most importantly, long-term mortality was higher in patients who developed RAH (39% vs. 21%, p = 0.026), and presenting with RAH independently predicted high mortality (HR: 1.55 [1.11-2.18]).

Conclusions: RAH is common and has a more aggressive clinical course, including increased mortality. Patients surviving an episode of AH should undergo intense alcohol use disorder therapy to prevent RAH.

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References

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