Giving up alcohol early on improves survival in cirrhosis
Stopping drinking a month after the diagnosis of cirrhosis is the most important predictor of survival, a British study has found. The severity of cirrhosis found on biopsy had little impact on survival.
The study followed 100 patients consecutively diagnosed with biopsy proven alcohol-induced cirrhosis at Southampton General Hospital. Patients with additional disease processes which were non-cirrhotic and patients without accurate mortality data were excluded from the study. Biopsies were scored for severity of cirrhosis by two independent observers. Data on drinking 30 days after diagnosis were available on all but four subjects.
Of the 100 subjects, 45 were female and 55 male, the median age was 49 years and median weekly alcohol intake was 126 units/week. The greatest number of deaths occurred within the first year after diagnosis. The percentage of patients surviving at 30 days, 1 year and 5 years after diagnosis respectively were 84%, 74% and 54%.
Surprisingly patients with the mildest histological cirrhosis had the worst survival at 1 year, 61% compared with 82% and 83% respectively for the two more severe categories of cirrhosis. At longer time-points survival curves converged, with no significant effect on survival of the severity of cirrhosis on biopsy.
Patients abstinent from alcohol 30 days after diagnosis had significantly improved long-term survival: 72% survived long term (median 7 years) compared with 44% of those who continued to drink. Even in the subset of patients with the most severe grades of cirrhosis the survival curve was flat after 4 years in abstainers, and the effect of drinking status was still highly significant.
Deaths from alcohol-related cirrhosis have increased in recent decades, along with a doubling of alcohol consumption in the UK.
This study clearly confirms that the single most important determinant of long-term prognosis in alcohol-induced cirrhosis is for the patient to stop drinking. For patients with cirrhosis, it is never too late.
Verrill C, Markham H, Templeton A, et al. Alcohol-related cirrhosis - early abstinence is a key factor in prognosis, even in the most severe cases. Addiction; 104: 768–774Reviewer
Dr Jez Thompson
GP and Clinical Director, NHS Hull Social Inclusion Services