Low alcohol consumption influences outcomes in individuals with alcohol-related compensated cirrhosis in a French multicenter cohort

Published:November 21, 2022DOI:


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        Alcohol recurrence occurs in more than 30% of cases after a diagnosis of cirrhosis
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        A history of drug abuse and a recent alcohol withdrawal are drivers of recurrence
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        Even a moderate recurrence influences outcome of patients with cirrhosis
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        Cirrhotic patients should be advised to completely stop alcohol, even at low levels


      Background and aims

      The harmful impact of heavy alcohol recurrence has been confirmed in patients with alcohol-related cirrhosis although this is based on old studies. The drivers of long-term outcome still need to be clearly investigated.


      All patients with biopsy-proven compensated alcohol-related cirrhosis included in the CIRRAL cohort (22 centers) were prospectively studied. Prognostic variables of survival and liver event-free survival were assessed using multivariable Cox models with stepwise selection. The prognostic impact of alcohol recurrence during follow-up (computed in glasses-years in the same way as pack-years for tobacco) was assessed using a time-dependent covariable.


      From 2010 to 2016, 650 patients were included. The median age at baseline was 58.4 years old, 67.4% were men and the median BMI was 27.8 kg/m2, 63.8% had a history of liver decompensation, and 70.2% had discontinued alcohol. At 5 years, 30.9% of abstinent patients developed recurrence and this risk was higher in patients with a history of drug abuse and in those with shorter alcohol discontinuation times. Median survival was 97 months. Age, alcohol consumption at baseline, platelet count and Child-Pugh score >5 were associated with overall and liver event-free survival on multivariate analysis. Alcohol consumption during follow-up of more than 25 glasses-year was independently associated with lower survival and with a trend toward significant liver event-free survival, but the risk increased from 1 glass-year, though not significantly. Simon & Makuch plots confirm the benefit of no alcohol consumption (<1 glass/week) on both outcomes and the dose-dependent impact of alcohol over time.


      This prospective study in patients with compensated alcohol-related cirrhosis identifies factors of alcohol recurrence during the follow-up and shows that moderate alcohol consumption during follow-up negatively impacts outcomes. Patients with alcohol-related cirrhosis should be advised to stop alcohol completely.

      Impact and implications

      In patients with alcohol-related cirrhosis, data are lacking about the impact of the amount of alcohol consumed on both survival and liver events. The present study based on the CIRRAL cohort demonstrates that alcohol recurrence occurs in more than 30% of patients with compensated cirrhosis and even a moderate recurrence strongly influences outcome. Patients with compensated alcohol-related cirrhosis should be advised to completely discontinue alcohol intake, even small amounts because, from the present study, no alcohol consumption can be regarded as safe when cirrhosis has developed.

      Graphical abstract



      AFP (alfa-fetoprotein), BMI (Body Mass Index), HBV (hepatitis B virus), HCV (hepatitis C virus), HCC (hepatocellular carcinoma), HR (hazard ratio), IQR (interquartile range), US (abdominal ultrasonography examination)
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