High alcohol relapse rate blamed for poor survival in liver-disease patients

Liver-disease patients are dying because of poor alcohol relapse rates after they leave hospital, according to a Brighton and Sussex Medical School study published.

Patients who do manage to stop drinking, however, are almost three times likely to survive.

The study, published on the Alimentary Pharmacology & Therapeutics journal online library, is one of the first to assess the long-term outcome for in-patients with severe alcoholic hepatitis (SAH).

It was carried out at Brighton and Sussex University Hospital (BSUH) and Brighton and Sussex Medical School (BSMS), run by the universities of Brighton and Sussex.

Dr Jonathan Potts, Research Fellow, and Dr Sumita Verma, Senior Lecturer and Honorary Consultant, Hepatology, reviewed medical records of patients admitted to BSUH with SAH from 2006-2011 and found that more than half the cohort, 58 per cent, were dead at the end of the study period, with 97 per cent of these deaths directly related to the liver disease.

Only 20 per cent of the patients died during the initial hospitalisation, which is comparable with other studies assessing short-term outcome in SAH. However, two-thirds of the deaths occurred after hospital discharge, and were directly related to the high rate of alcohol relapse (65 per cent).

Those who remained free of alcohol were almost three times more likely to be alive than those who suffered an alcohol relapse. The estimated five-year survival was 75 per cent in those who stopped drinking, compared to 24 per cent in those with alcohol relapse.

Dr Verma said: "The results of this study are worrying. Our inpatient mortality is similar to other centres nationally and internationally, which suggests that our medical management of such patients during their initial hospital stay is excellent.

"However, the overall survival is very poor and this is directly related to the high rate of alcohol relapse after discharge from hospital. This is despite the fact that Brighton has well-developed and comprehensive hospital and community alcohol services.

"Our study highlights the urgent need for further multi-disciplinary research in this area, especially focusing on the use of anti-craving drugs in patients recently discharged with a diagnosis of SAH."

Alimentary Pharmacology and Therapeutics onlinelibrary.wiley.com/doi/10.1111/apt.12427/full