Histological parameters and alcohol abstinence determine long-term prognosis in patients with alcoholic liver disease

Lackner, Carolin; Spindelboeck, Walter; Haybaeck, Johannes; Douschan, Philipp; Rainer, Florian; Terracciano, Luigi; Haas, Josef; Berghold, Andrea; Bataller, Ramón; Stauber, Rudolf

doi:10.1016/j.jhep.2016.11.011

Cited by 224 publications

(194 citation statements)

References 52 publications

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“…Patients at high risk for HE should be offered a suite of clinical and lifestyle changes to promote improved liver function. At a minimum, this includes the eradication of hepatitis C if present, intensified treatment for alcohol abuse, and specific guidance on nutritional intake (i.e., ≥1.25 g/kg protein daily), each of which is associated with improved liver function (i.e., albumin and/or bilirubin). Additionally, there may be a chemopreventive role for statins.…”

Section: Discussionmentioning

confidence: 99%

A risk score to predict the development of hepatic encephalopathy in a population‐based cohort of patients with cirrhosis

et al. 2018

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Section: Discussionmentioning

confidence: 99%

A risk score to predict the development of hepatic encephalopathy in a population‐based cohort of patients with cirrhosis

et al. 2018

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“…Key features are a significant increase in proinflammatory cytokines like tumor necrosis factor α (TNFα) and interleukins (IL)-1 and -6. Alcohol abstinence has demonstrated to benefit these patients by improving the prognosis in early and advanced stages [18]. Pentoxifylline and prednisolone improve short-time survival of AH and continue to be the main treatment for these patients, although corticosteroids could be detrimental since they increase the risk of bleeding and infections [19].…”

Section: Alcoholic Hepatitismentioning

confidence: 99%

“…In patients with decompensated ALD, cirrhosis is more frequent and features of hepatocellular damage, lobular inflammation, hepatocellular ballooning degeneration and hepatocyte drop-out, megamitochondria and the appearance of Mallory–Denk bodies are more dominant [18]. Liver cirrhosis leads to severe complications, such as variceal bleeding, ascites and hepatic encephalopathy.…”

Section: Alcoholic Cirrhosismentioning

confidence: 99%

Key Events Participating in the Pathogenesis of Alcoholic Liver Disease

2017

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Alcoholic liver disease (ALD) is a leading cause of morbidity and mortality worldwide. It ranges from fatty liver to steatohepatitis, fibrosis, cirrhosis and hepatocellular carcinoma. The most prevalent forms of ALD are alcoholic fatty liver, alcoholic hepatitis (AH) and alcoholic cirrhosis, which frequently progress as people continue drinking. ALD refers to a number of symptoms/deficits that contribute to liver injury. These include steatosis, inflammation, fibrosis and cirrhosis, which, when taken together, sequentially or simultaneously lead to significant disease progression. The pathogenesis of ALD, influenced by host and environmental factors, is currently only partially understood. To date, lipopolysaccharide (LPS) translocation from the gut to the portal blood, aging, gender, increased infiltration and activation of neutrophils and bone marrow-derived macrophages along with alcohol plus iron metabolism, with its associated increase in reactive oxygen species (ROS), are all key events contributing to the pathogenesis of ALD. This review aims to introduce the reader to the concept of alcohol-mediated liver damage and the mechanisms driving injury.

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“…[10–13, 15–21] However, physicians need to be vigilant as these patients unpredictably may transition to F4 stage. In this regard, data are needed on the use of non-invasive serum and radiological markers including fibroscan and transient elastography, as basis for cost-effective management of these patients in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Patients with stage 3 compared to stage 4 liver fibrosis have lower frequency of and longer time to liver disease complications

Axley¹,

Mudumbi²,

Sarker³

et al. 2018

PLoS ONE

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Background and aimsAdvanced liver fibrosis is an important predictor of liver disease progression and mortality, and current guidelines recommend screening for complications of cirrhosis once patients develop F3 fibrosis. Our study compared liver disease progression and survival in patients with stage 3 (F3) and stage 4 (F4) fibrosis on liver biopsy.MethodsRetrospective study of patients with F3 or F4 on liver biopsy followed for development of liver disease complications (variceal bleeding, ascites, and hepatic encephalopathy); hepatocellular carcinoma, and survival (overall and transplant free survival).ResultsOf 2488 patients receiving liver biopsy between 01/02 and 12/12, a total of 294 (171 F3) were analyzed. Over a median follow up period of 3 years, patients with F4 (mean age 53 years, 63% male) compared to F3 (mean age 49 years, 43% male) had higher five year cumulative probability of any decompensation (38% vs. 14%, p<0.0001), including variceal bleed (10% vs. 4%, p = 0.014), ascites (21% vs. 9%, p = 0.0014), and hepatic encephalopathy (14% vs. 5%, p = 0.003). F4 patients also had lower overall 5-year survival (80% vs. 93%, p = 0.003) and transplant free survival (80% vs. 93%, p = 0.002). Probability of hepatocellular carcinoma in 5 years after biopsy was similar between F3 and F4 (1.2% vs. 2%, p = 0.54).ConclusionsCompared to F4 stage, patients with F3 fibrosis have decreased risk for development of liver disease complications and better survival. Prospective well designed studies are suggested with large sample size and overcoming the limitations identified in this study, to confirm and validate these findings, as basis for modifying guidelines and recommendations on follow up of patients with advanced fibrosis and stage 3 liver fibrosis.

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Histological parameters and alcohol abstinence determine long-term prognosis in patients with alcoholic liver disease

Cited by 224 publications

References 52 publications

A risk score to predict the development of hepatic encephalopathy in a population‐based cohort of patients with cirrhosis

A risk score to predict the development of hepatic encephalopathy in a population‐based cohort of patients with cirrhosis

Key Events Participating in the Pathogenesis of Alcoholic Liver Disease

Patients with stage 3 compared to stage 4 liver fibrosis have lower frequency of and longer time to liver disease complications

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