Materiały źródłowe

• #1 Alcohol-associated liver disease: Epidemiology and management | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-alcohol-associated-liver-disease-epidemiology-management-S166526812300265X

  Alcohol is the leading cause of preventable liver morbidity and mortality worldwide, as it is also the most frequent cause of advanced liver disease. […] Currently, there are no approved targeted therapies able to interfere in the pathogenesis of ALD and halt the progression of the disease, therefore alcohol abstinence is the most effective measure to improve prognosis in this patient population. […] In patients with advanced ALD nonresponding to medical therapy, liver transplantation is the only approach that improves prognosis, and it should be considered in patients with decompensated cirrhosis. […] In the last years, AH has emerged as a new indication of early liver transplantation in non-responders to medical therapy, with promising results in highly selected patients. […] To date, there are no well-validated tools to predict who will develop advanced liver disease secondary to alcohol consumption.

• #2 Alcohol-Related Liver Disease – Hepatic and Biliary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/alcohol-related-liver-disease/alcohol-related-liver-disease

  Prognosis is determined by the degree of hepatic fibrosis and inflammation. Hepatic steatosis and alcoholic hepatitis without fibrosis are reversible if alcohol is avoided. With abstinence, hepatic steatosis may completely resolve within 6 weeks. Fibrosis and cirrhosis are usually irreversible. […] Certain biopsy findings (eg, neutrophils, perivenular fibrosis) indicate a worse prognosis. Proposed quantitative indexes to predict severity and mortality use primarily laboratory features of liver failure such as prothrombin time, creatinine (for hepatorenal syndrome), and bilirubin levels. The Maddrey discriminant function may be used; it is calculated from the following formula: […] Once cirrhosis and its complications (eg, ascites, bleeding) develop, the 5-year survival rate is about 50%; survival is higher in patients who abstain and lower in patients who continue drinking. […] Coexisting iron accumulation or chronic hepatitis C increases risk of hepatocellular carcinoma.

• #3 Alcohol-Associated Liver Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK546632/

  Prognosis in early-stage liver disease is good since steatosis and steatohepatitis lesions may be reversible after alcohol cessation. However, up to 20% of patients with steatosis may still progress to cirrhosis. Lesions associated with cirrhosis are irreversible, and the prognosis is poor. Screening for hepatocellular carcinoma is imperative at this stage. The presence of ascites, variceal bleeding, severe encephalopathy, and hepatorenal syndrome also indicate poor prognosis. […] The Model for End-Stage Liver Disease (MELD) score was adopted by the United Network for Organ Sharing (UNOS) to prioritize patients waiting for a liver transplant due to its ability to predict 90-day mortality. In 2016 the Organ Procurement and Transplantation Network (OPTN) in conjunction with UNOS announced the inclusion of sodium into the MELD score for patients greater than 12 years of age with a MELD score greater than 11. 90-day mortality based on meld score is 1.9% for MELD 10, 6% for 10-19, 19.6% for 20-29, 52.6% for 30-39, and 71.3% for 40. […] DF is also a useful predictive tool, and patients with alcoholic hepatitis and a DF greater than 32 have a 50% 30-day mortality.

• #4 Alcohol-Related Liver Disease – Hepatic and Biliary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/alcohol-related-liver-disease/alcohol-related-liver-disease

  Prognosis is determined by the degree of hepatic fibrosis and inflammation. Hepatic steatosis and alcoholic hepatitis without fibrosis are reversible if alcohol is avoided. With abstinence, hepatic steatosis may completely resolve within 6 weeks. Fibrosis and cirrhosis are usually irreversible. […] Certain biopsy findings (eg, neutrophils, perivenular fibrosis) indicate a worse prognosis. Proposed quantitative indexes to predict severity and mortality use primarily laboratory features of liver failure such as prothrombin time, creatinine (for hepatorenal syndrome), and bilirubin levels. The Maddrey discriminant function may be used; it is calculated from the following formula: […] Once cirrhosis and its complications (eg, ascites, bleeding) develop, the 5-year survival rate is about 50%; survival is higher in patients who abstain and lower in patients who continue drinking. […] Coexisting iron accumulation or chronic hepatitis C increases risk of hepatocellular carcinoma.

• #5 Predictive Factors for the Prognosis of Alcoholic Liver Cirrhosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9786187/

  Alcoholic liver cirrhosis (ALC) is a disease with multiple complications and is associated with poor prognosis and significant mortality. Identifying risk factors associated with a poor outcome is important to ensure effective treatment and increase life expectancy. […] The prognosis of the disease was negatively influenced by the worsening of liver dysfunction and the appearance of complications. The main predictors of mortality were infections, hepatic encephalopathy, variceal bleeding, and hepatorenal syndrome. Improving compliance and strict application of specific follow-up and treatment strategies could contribute to a better prognosis of patients with alcoholic liver cirrhosis. […] The independent predictors confirmed by multivariate analysis were the association of variceal bleeding, infections, and hepatic encephalopathy or ascites, each combination being responsible for two out of 10 of the deaths during the first admission.

• #6 Predictive Factors for the Prognosis of Alcoholic Liver Cirrhosis

  https://www.mdpi.com/1648-9144/58/12/1859

  Predictive factors for the prognosis of alcoholic liver cirrhosis are crucial for understanding patient outcomes. Alcoholic liver cirrhosis (ALC) is a disease with multiple complications and is associated with poor prognosis and significant mortality. Identifying risk factors associated with a poor outcome is important to ensure effective treatment and increase life expectancy. The prognosis of the disease was negatively influenced by the worsening of liver dysfunction and the appearance of complications. The main predictors of mortality were infections, hepatic encephalopathy, variceal bleeding, and hepatorenal syndrome. Improving compliance and strict application of specific follow-up and treatment strategies could contribute to a better prognosis of patients with alcoholic liver cirrhosis.

• #7 Alcohol-associated liver disease: Epidemiology and management | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-alcohol-associated-liver-disease-epidemiology-management-S166526812300265X

  The risk of developing cirrhosis in the setting of AUD is related to host susceptibility, including genetic and environmental factors. […] The presence of histological factors of alcoholic hepatitis and advanced cirrhosis predict survival and decompensation in the short-term. […] Complete alcohol cessation has a positive impact on long-term survival, and it is the best predictive factor of long-term mortality. […] The decision to indicate an early LT in the setting of AH should be carefully balanced due to the previously discussed circumstances.

• #8 Predictive Factors for the Prognosis of Alcoholic Liver Cirrhosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9786187/

  Alcoholic liver cirrhosis (ALC) is a disease with multiple complications and is associated with poor prognosis and significant mortality. Identifying risk factors associated with a poor outcome is important to ensure effective treatment and increase life expectancy. […] The prognosis of the disease was negatively influenced by the worsening of liver dysfunction and the appearance of complications. The main predictors of mortality were infections, hepatic encephalopathy, variceal bleeding, and hepatorenal syndrome. Improving compliance and strict application of specific follow-up and treatment strategies could contribute to a better prognosis of patients with alcoholic liver cirrhosis. […] The independent predictors confirmed by multivariate analysis were the association of variceal bleeding, infections, and hepatic encephalopathy or ascites, each combination being responsible for two out of 10 of the deaths during the first admission.

• #9 Predictive Factors for the Prognosis of Alcoholic Liver Cirrhosis

  https://www.mdpi.com/1648-9144/58/12/1859

  The independent predictors confirmed by multivariate analysis were the association of variceal bleeding, infections, and hepatic encephalopathy or ascites, each combination being responsible for two out of 10 of the deaths during the first admission. […] The complications of the disease, univariately analyzed, negatively affected the survival rate, with significant values being linked to infections (sepsis: OR = 21.98; p < 0.001; spontaneous bacterial peritonitis: OR = 11.94; p < 0.001) and hepatorenal syndrome (OR = 9.35; p < 0.001), which increased the risk of death at least 10–20 times.

• #10 Predictive Factors for the Prognosis of Alcoholic Liver Cirrhosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9786187/

  The complications of the disease, univariately analyzed, negatively affected the survival rate, with significant values being linked to infections (sepsis: OR = 21.98; p 0.001; spontaneous bacterial peritonitis: OR = 11.94; p 0.001) and hepatorenal syndrome (OR = 9.35; p 0.001), which increased the risk of death at least 10-20 times. […] The performance of the scores used to assess liver dysfunction (CTP and MELD-Na) was analyzed based on the ROC curve. […] The same trend can be observed regarding the MELD-Na score, with an increase up to 19.1 6.94 from 15.52 7.08 (p = 0.025). […] The prognosis of the disease is negatively influenced by the worsening of liver dysfunction and the occurrence of complications. In this study, we found that the main predictors for mortality are infections, hepatic encephalopathy, variceal bleeding, and hepatorenal syndrome.

• #11 Predictive Factors for the Prognosis of Alcoholic Liver Cirrhosis

  https://www.mdpi.com/1648-9144/58/12/1859

  The independent predictors confirmed by multivariate analysis were the association of variceal bleeding, infections, and hepatic encephalopathy or ascites, each combination being responsible for two out of 10 of the deaths during the first admission. […] The complications of the disease, univariately analyzed, negatively affected the survival rate, with significant values being linked to infections (sepsis: OR = 21.98; p < 0.001; spontaneous bacterial peritonitis: OR = 11.94; p < 0.001) and hepatorenal syndrome (OR = 9.35; p < 0.001), which increased the risk of death at least 10–20 times.

• #12 Predictive Factors for the Prognosis of Alcoholic Liver Cirrhosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9786187/

  The complications of the disease, univariately analyzed, negatively affected the survival rate, with significant values being linked to infections (sepsis: OR = 21.98; p 0.001; spontaneous bacterial peritonitis: OR = 11.94; p 0.001) and hepatorenal syndrome (OR = 9.35; p 0.001), which increased the risk of death at least 10-20 times. […] The performance of the scores used to assess liver dysfunction (CTP and MELD-Na) was analyzed based on the ROC curve. […] The same trend can be observed regarding the MELD-Na score, with an increase up to 19.1 6.94 from 15.52 7.08 (p = 0.025). […] The prognosis of the disease is negatively influenced by the worsening of liver dysfunction and the occurrence of complications. In this study, we found that the main predictors for mortality are infections, hepatic encephalopathy, variceal bleeding, and hepatorenal syndrome.

• #13 Alcohol-Associated Liver Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK546632/

  Prognosis in early-stage liver disease is good since steatosis and steatohepatitis lesions may be reversible after alcohol cessation. However, up to 20% of patients with steatosis may still progress to cirrhosis. Lesions associated with cirrhosis are irreversible, and the prognosis is poor. Screening for hepatocellular carcinoma is imperative at this stage. The presence of ascites, variceal bleeding, severe encephalopathy, and hepatorenal syndrome also indicate poor prognosis. […] The Model for End-Stage Liver Disease (MELD) score was adopted by the United Network for Organ Sharing (UNOS) to prioritize patients waiting for a liver transplant due to its ability to predict 90-day mortality. In 2016 the Organ Procurement and Transplantation Network (OPTN) in conjunction with UNOS announced the inclusion of sodium into the MELD score for patients greater than 12 years of age with a MELD score greater than 11. 90-day mortality based on meld score is 1.9% for MELD 10, 6% for 10-19, 19.6% for 20-29, 52.6% for 30-39, and 71.3% for 40. […] DF is also a useful predictive tool, and patients with alcoholic hepatitis and a DF greater than 32 have a 50% 30-day mortality.

• #14 Predictive Factors for the Prognosis of Alcoholic Liver Cirrhosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9786187/

  The complications of the disease, univariately analyzed, negatively affected the survival rate, with significant values being linked to infections (sepsis: OR = 21.98; p 0.001; spontaneous bacterial peritonitis: OR = 11.94; p 0.001) and hepatorenal syndrome (OR = 9.35; p 0.001), which increased the risk of death at least 10-20 times. […] The performance of the scores used to assess liver dysfunction (CTP and MELD-Na) was analyzed based on the ROC curve. […] The same trend can be observed regarding the MELD-Na score, with an increase up to 19.1 6.94 from 15.52 7.08 (p = 0.025). […] The prognosis of the disease is negatively influenced by the worsening of liver dysfunction and the occurrence of complications. In this study, we found that the main predictors for mortality are infections, hepatic encephalopathy, variceal bleeding, and hepatorenal syndrome.

• #15 Alcohol-Associated Liver Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK546632/

  Prognosis in early-stage liver disease is good since steatosis and steatohepatitis lesions may be reversible after alcohol cessation. However, up to 20% of patients with steatosis may still progress to cirrhosis. Lesions associated with cirrhosis are irreversible, and the prognosis is poor. Screening for hepatocellular carcinoma is imperative at this stage. The presence of ascites, variceal bleeding, severe encephalopathy, and hepatorenal syndrome also indicate poor prognosis. […] The Model for End-Stage Liver Disease (MELD) score was adopted by the United Network for Organ Sharing (UNOS) to prioritize patients waiting for a liver transplant due to its ability to predict 90-day mortality. In 2016 the Organ Procurement and Transplantation Network (OPTN) in conjunction with UNOS announced the inclusion of sodium into the MELD score for patients greater than 12 years of age with a MELD score greater than 11. 90-day mortality based on meld score is 1.9% for MELD 10, 6% for 10-19, 19.6% for 20-29, 52.6% for 30-39, and 71.3% for 40. […] DF is also a useful predictive tool, and patients with alcoholic hepatitis and a DF greater than 32 have a 50% 30-day mortality.

• #16 Alcohol-Associated Liver Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK546632/

  Prognosis in early-stage liver disease is good since steatosis and steatohepatitis lesions may be reversible after alcohol cessation. However, up to 20% of patients with steatosis may still progress to cirrhosis. Lesions associated with cirrhosis are irreversible, and the prognosis is poor. Screening for hepatocellular carcinoma is imperative at this stage. The presence of ascites, variceal bleeding, severe encephalopathy, and hepatorenal syndrome also indicate poor prognosis. […] The Model for End-Stage Liver Disease (MELD) score was adopted by the United Network for Organ Sharing (UNOS) to prioritize patients waiting for a liver transplant due to its ability to predict 90-day mortality. In 2016 the Organ Procurement and Transplantation Network (OPTN) in conjunction with UNOS announced the inclusion of sodium into the MELD score for patients greater than 12 years of age with a MELD score greater than 11. 90-day mortality based on meld score is 1.9% for MELD 10, 6% for 10-19, 19.6% for 20-29, 52.6% for 30-39, and 71.3% for 40. […] DF is also a useful predictive tool, and patients with alcoholic hepatitis and a DF greater than 32 have a 50% 30-day mortality.

• #17 Predictive Factors for the Prognosis of Alcoholic Liver Cirrhosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9786187/

  The complications of the disease, univariately analyzed, negatively affected the survival rate, with significant values being linked to infections (sepsis: OR = 21.98; p 0.001; spontaneous bacterial peritonitis: OR = 11.94; p 0.001) and hepatorenal syndrome (OR = 9.35; p 0.001), which increased the risk of death at least 10-20 times. […] The performance of the scores used to assess liver dysfunction (CTP and MELD-Na) was analyzed based on the ROC curve. […] The same trend can be observed regarding the MELD-Na score, with an increase up to 19.1 6.94 from 15.52 7.08 (p = 0.025). […] The prognosis of the disease is negatively influenced by the worsening of liver dysfunction and the occurrence of complications. In this study, we found that the main predictors for mortality are infections, hepatic encephalopathy, variceal bleeding, and hepatorenal syndrome.

• #18 Alcohol-Associated Liver Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK546632/

  Prognosis in early-stage liver disease is good since steatosis and steatohepatitis lesions may be reversible after alcohol cessation. However, up to 20% of patients with steatosis may still progress to cirrhosis. Lesions associated with cirrhosis are irreversible, and the prognosis is poor. Screening for hepatocellular carcinoma is imperative at this stage. The presence of ascites, variceal bleeding, severe encephalopathy, and hepatorenal syndrome also indicate poor prognosis. […] The Model for End-Stage Liver Disease (MELD) score was adopted by the United Network for Organ Sharing (UNOS) to prioritize patients waiting for a liver transplant due to its ability to predict 90-day mortality. In 2016 the Organ Procurement and Transplantation Network (OPTN) in conjunction with UNOS announced the inclusion of sodium into the MELD score for patients greater than 12 years of age with a MELD score greater than 11. 90-day mortality based on meld score is 1.9% for MELD 10, 6% for 10-19, 19.6% for 20-29, 52.6% for 30-39, and 71.3% for 40. […] DF is also a useful predictive tool, and patients with alcoholic hepatitis and a DF greater than 32 have a 50% 30-day mortality.

• #19 Alcoholic Hepatitis (Alcohol-Associated Hepatitis): Background, Etiology and Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/170539-overview

  During the past several decades, various formulas and algorithms have been proposed for predicting the outcome of severe alcoholic hepatitis. The single most reliable indicator of severity is the presence of hepatic encephalopathy. […] The Maddrey discriminant function (MDF) is based on PT and bilirubin levels, and it is calculated as follows: DF = (4.6 PT prolongation) + total serum bilirubin in mg/dL. Values greater than 32 indicate severe disease and predict a 30-day mortality rate of approximately 50%, assuming only supportive treatment is given. […] Other factors that correlate with poor prognosis include older age, impaired renal function, encephalopathy, and a rise in the WBC count in the first 2 weeks of hospitalization.

• #20 Alcohol-related cancer morbidity and mortality are stratified using modified albumin platelet product | Scientific Reports

  https://www.nature.com/articles/s41598-023-50778-x

  Alcohol abuse is associated with several diseases, such as hepatocellular carcinoma, cirrhosis, and extrahepatic malignancies. […] This retrospective cohort study aimed to extend application of APP and mAPP in prognosis prediction of patients with alcoholic liver diseases. […] Thus, APP=4.349 and mAPP=2.484 significantly differentiated cancer-free survival and overall survival in univariate analysis. […] Multivariate analysis revealed mAPP=2.484 as an independent risk factor for carcinogenesis and overall death. […] In conclusion, mAPP is a simple index to stratify patients risk for carcinogenesis and death. […] The present study aimed to extend the clinical application of APP and mAPP as prognostic indicators for patients with alcoholic liver diseases. […] A total of 29 patients died during the follow-up period.

• #21 Alcohol-related cancer morbidity and mortality are stratified using modified albumin platelet product | Scientific Reports

  https://www.nature.com/articles/s41598-023-50778-x

  A univariate analysis was conducted to determine the prognostic abilities of APP and mAPP, compared to that of the albumin-bilirubin (ALBI) score and fibrosis-4 (FIB-4) index. […] Consequently, a mAPP score of 2.484 was the best among APP, mAPP, ALBI grade, and FIB-4 index for stratifying cancer-free, overall, and HCC-free survival rates. […] mAPP was an independent risk factor for all endpoints, including carcinogenesis (HR, 2.477; p=0.0072), carcinogenesis or death (HR, 3.244; p=0.0003), and overall death (HR, 3.622; p=0.0007). […] Our findings suggest that mAPP can effectively stratify the prognosis of patients, even those in the early stages of alcoholic liver diseases. […] In conclusion, mAPP can predict cancer-free and overall survival.

• #22 Prevalence and prediction of hepatocellular carcinoma in alcohol-associated liver disease: a retrospective study of 136 571 patients with chronic liver diseases | eGastroenterology

  https://egastroenterology.bmj.com/content/2/1/e100036

  The prevalence of ALD and ALD-related HCC has been increased dramatically. […] A nomogram had a concordance index of 0.786 (95% CI 0.773 to 0.799) and had well-fitted calibration curves. […] The nomogram model established here with its high accuracy and easy-to-use features achieved an optimal prediction of HCC development in patients with ALD, which can help clinicians to develop an individualised and precise treatment strategy. […] This study provided the evidence that can help clinicians in formulating personalised and precise treatment strategies aimed at reducing the mortality rate associated with ALD-related HCC. […] The present study clarified that longer years of drinking, older age, diabetes mellitus, HBV infection, liver cirrhosis and male sex were the high-risk factors for ALD-related HCC by multivariate analysis, which is in agreement with recent findings.

• #23 Prevalence and prediction of hepatocellular carcinoma in alcohol-associated liver disease: a retrospective study of 136 571 patients with chronic liver diseases | eGastroenterology

  https://egastroenterology.bmj.com/content/2/1/e100036

  In the present study, a novel nomogram model scoring from 0 to 240 points was established based on logistic regression. The nomogram demonstrated good accuracy in estimating the risk of HCC development, with a C-index of 0.786 (95% CI 0.773 to 0.799). Patients with ALD could be categorised into low-risk, medium-risk and high-risk groups for HCC development using this nomogram and could be managed more conveniently and efficiently to improve surveillance and treatment.

• #24 Alcoholic liver disease: A registry view on comorbidities and disease prediction | PLOS Computational Biology

  https://journals.plos.org/ploscompbiol/article?id=10.1371/journal.pcbi.1008244

  We perform a matched casecontrol study using the group of patients with ALC as cases and their matched patients with non-ALD as controls. Machine learning models (SVM, RF, LightGBM and NaiveBayes) trained and tested on the set of ALC patients achieve a high performance for data classification (AUC = 0.89). When testing the same trained models on the small set of ALF patients, their performance unsurprisingly drops a lot (AUC = 0.67 for NaiveBayes). The statistical and machine learning results underscore small groups of upstream and downstream comorbidities that accurately detect ALC patients and show promise in prediction of ALF. […] Unfortunately, people with fibrosis or reversible early-stage cirrhosis of the liver usually are asymptomatic, that is they do not exhibit any symptoms of disease. Most patients are thus only discovered in late stages when complications to ALC cause the healthcare system to suspect liver disease (75% of patients are diagnosed at a late stage, when 5-year survival may be down to 12% [9]). In this context, we present a machine-learning approach for the early detection of fibrosis or cirrhosis in ALD, that enables to identify at-risk patients with ALF and early cirrhosis before they reach the more advanced stage with complications to ALC [10].

• #25 Alcoholic Hepatitis (Alcohol-Associated Hepatitis): Background, Etiology and Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/170539-overview

  The long-term prognosis of individuals with alcoholic hepatitis depends heavily on whether patients have established cirrhosis and whether they continue to drink. With abstinence, patients with this disease exhibit progressive improvement in liver function over months to years, and the histologic features of active alcoholic hepatitis resolve. If alcohol abuse continues, alcoholic hepatitis invariably persists and progresses to cirrhosis over months to years. In one study, the estimated 5-year survival after hospitalization for severe alcoholic hepatitis was 31.8%. Abstinence was the only independent predictor of long-term survival. […] Annualized rates of progression of precirrhotic disease to cirrhosis are reported to be 1% (0-8%) for patients with normal histology, 3% (2-4%) for hepatic steatosis, 10% (6-17%) for steatohepatitis, and 8% (3-19%) for fibrosis. The annualized mortality for patients with steatosis or cirrhosis is, respectively, 6% (4-7%) and 8% (5-13%). Alcohol-related hepatic steatohepatitis requiring inpatient admission is the most dangerous subtype of alcohol-related liver disease.

• #26 Alcoholic Hepatitis (Alcohol-Associated Hepatitis): Background, Etiology and Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/170539-overview

  The long-term prognosis of individuals with alcoholic hepatitis depends heavily on whether patients have established cirrhosis and whether they continue to drink. With abstinence, patients with this disease exhibit progressive improvement in liver function over months to years, and the histologic features of active alcoholic hepatitis resolve. If alcohol abuse continues, alcoholic hepatitis invariably persists and progresses to cirrhosis over months to years. In one study, the estimated 5-year survival after hospitalization for severe alcoholic hepatitis was 31.8%. Abstinence was the only independent predictor of long-term survival. […] Annualized rates of progression of precirrhotic disease to cirrhosis are reported to be 1% (0-8%) for patients with normal histology, 3% (2-4%) for hepatic steatosis, 10% (6-17%) for steatohepatitis, and 8% (3-19%) for fibrosis. The annualized mortality for patients with steatosis or cirrhosis is, respectively, 6% (4-7%) and 8% (5-13%). Alcohol-related hepatic steatohepatitis requiring inpatient admission is the most dangerous subtype of alcohol-related liver disease.

• #27 Alcoholic Hepatitis (Alcohol-Associated Hepatitis): Background, Etiology and Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/170539-overview

  The long-term prognosis of individuals with alcoholic hepatitis depends heavily on whether patients have established cirrhosis and whether they continue to drink. With abstinence, patients with this disease exhibit progressive improvement in liver function over months to years, and the histologic features of active alcoholic hepatitis resolve. If alcohol abuse continues, alcoholic hepatitis invariably persists and progresses to cirrhosis over months to years. In one study, the estimated 5-year survival after hospitalization for severe alcoholic hepatitis was 31.8%. Abstinence was the only independent predictor of long-term survival. […] Annualized rates of progression of precirrhotic disease to cirrhosis are reported to be 1% (0-8%) for patients with normal histology, 3% (2-4%) for hepatic steatosis, 10% (6-17%) for steatohepatitis, and 8% (3-19%) for fibrosis. The annualized mortality for patients with steatosis or cirrhosis is, respectively, 6% (4-7%) and 8% (5-13%). Alcohol-related hepatic steatohepatitis requiring inpatient admission is the most dangerous subtype of alcohol-related liver disease.

• #28 Alcoholic Hepatitis (Alcohol-Associated Hepatitis): Background, Etiology and Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/170539-overview

  Mild alcoholic hepatitis is a benign disorder with negligible short-term mortality. However, when alcoholic hepatitis is of sufficient severity to cause hepatic encephalopathy, jaundice, or coagulopathy, mortality can be substantial. […] The overall 30-day mortality rate in patients hospitalized with alcoholic hepatitis is approximately 15%; however, in patients with severe liver disease, the rate approaches or exceeds 50%. In those lacking encephalopathy, jaundice, or coagulopathy, the 30-day mortality rate is less than 5%. Overall, the 1-year mortality rate after hospitalization for alcoholic hepatitis is approximately 40%. […] In one study, the overall mortality among patients with severe alcoholic hepatitis was 66%. Age, white blood cell (WBC) count, prothrombin time (PT), and female sex were all independent risk factors for the dismal outcome.

• #29 Alcoholic Hepatitis (Alcohol-Associated Hepatitis): Background, Etiology and Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/170539-overview

  Mild alcoholic hepatitis is a benign disorder with negligible short-term mortality. However, when alcoholic hepatitis is of sufficient severity to cause hepatic encephalopathy, jaundice, or coagulopathy, mortality can be substantial. […] The overall 30-day mortality rate in patients hospitalized with alcoholic hepatitis is approximately 15%; however, in patients with severe liver disease, the rate approaches or exceeds 50%. In those lacking encephalopathy, jaundice, or coagulopathy, the 30-day mortality rate is less than 5%. Overall, the 1-year mortality rate after hospitalization for alcoholic hepatitis is approximately 40%. […] In one study, the overall mortality among patients with severe alcoholic hepatitis was 66%. Age, white blood cell (WBC) count, prothrombin time (PT), and female sex were all independent risk factors for the dismal outcome.

• #30 Alcohol-Related Liver Disease – Hepatic and Biliary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/alcohol-related-liver-disease/alcohol-related-liver-disease

  Prognosis is determined by the degree of hepatic fibrosis and inflammation. Hepatic steatosis and alcoholic hepatitis without fibrosis are reversible if alcohol is avoided. With abstinence, hepatic steatosis may completely resolve within 6 weeks. Fibrosis and cirrhosis are usually irreversible. […] Certain biopsy findings (eg, neutrophils, perivenular fibrosis) indicate a worse prognosis. Proposed quantitative indexes to predict severity and mortality use primarily laboratory features of liver failure such as prothrombin time, creatinine (for hepatorenal syndrome), and bilirubin levels. The Maddrey discriminant function may be used; it is calculated from the following formula: […] Once cirrhosis and its complications (eg, ascites, bleeding) develop, the 5-year survival rate is about 50%; survival is higher in patients who abstain and lower in patients who continue drinking. […] Coexisting iron accumulation or chronic hepatitis C increases risk of hepatocellular carcinoma.

• #31 Alcoholic Hepatitis (Alcohol-Associated Hepatitis): Background, Etiology and Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/170539-overview

  The long-term prognosis of individuals with alcoholic hepatitis depends heavily on whether patients have established cirrhosis and whether they continue to drink. With abstinence, patients with this disease exhibit progressive improvement in liver function over months to years, and the histologic features of active alcoholic hepatitis resolve. If alcohol abuse continues, alcoholic hepatitis invariably persists and progresses to cirrhosis over months to years. In one study, the estimated 5-year survival after hospitalization for severe alcoholic hepatitis was 31.8%. Abstinence was the only independent predictor of long-term survival. […] Annualized rates of progression of precirrhotic disease to cirrhosis are reported to be 1% (0-8%) for patients with normal histology, 3% (2-4%) for hepatic steatosis, 10% (6-17%) for steatohepatitis, and 8% (3-19%) for fibrosis. The annualized mortality for patients with steatosis or cirrhosis is, respectively, 6% (4-7%) and 8% (5-13%). Alcohol-related hepatic steatohepatitis requiring inpatient admission is the most dangerous subtype of alcohol-related liver disease.

• #32 Prevalence and prediction of hepatocellular carcinoma in alcohol-associated liver disease: a retrospective study of 136 571 patients with chronic liver diseases | eGastroenterology

  https://egastroenterology.bmj.com/content/2/1/e100036

  The prevalence of ALD and ALD-related HCC has been increased dramatically. […] A nomogram had a concordance index of 0.786 (95% CI 0.773 to 0.799) and had well-fitted calibration curves. […] The nomogram model established here with its high accuracy and easy-to-use features achieved an optimal prediction of HCC development in patients with ALD, which can help clinicians to develop an individualised and precise treatment strategy. […] This study provided the evidence that can help clinicians in formulating personalised and precise treatment strategies aimed at reducing the mortality rate associated with ALD-related HCC. […] The present study clarified that longer years of drinking, older age, diabetes mellitus, HBV infection, liver cirrhosis and male sex were the high-risk factors for ALD-related HCC by multivariate analysis, which is in agreement with recent findings.

• #33 Alcohol-Related Liver Disease – Hepatic and Biliary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/alcohol-related-liver-disease/alcohol-related-liver-disease

  Prognosis is determined by the degree of hepatic fibrosis and inflammation. Hepatic steatosis and alcoholic hepatitis without fibrosis are reversible if alcohol is avoided. With abstinence, hepatic steatosis may completely resolve within 6 weeks. Fibrosis and cirrhosis are usually irreversible. […] Certain biopsy findings (eg, neutrophils, perivenular fibrosis) indicate a worse prognosis. Proposed quantitative indexes to predict severity and mortality use primarily laboratory features of liver failure such as prothrombin time, creatinine (for hepatorenal syndrome), and bilirubin levels. The Maddrey discriminant function may be used; it is calculated from the following formula: […] Once cirrhosis and its complications (eg, ascites, bleeding) develop, the 5-year survival rate is about 50%; survival is higher in patients who abstain and lower in patients who continue drinking. […] Coexisting iron accumulation or chronic hepatitis C increases risk of hepatocellular carcinoma.

• #34 Alcohol-associated liver disease: Epidemiology and management | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-alcohol-associated-liver-disease-epidemiology-management-S166526812300265X

  Alcohol is the leading cause of preventable liver morbidity and mortality worldwide, as it is also the most frequent cause of advanced liver disease. […] Currently, there are no approved targeted therapies able to interfere in the pathogenesis of ALD and halt the progression of the disease, therefore alcohol abstinence is the most effective measure to improve prognosis in this patient population. […] In patients with advanced ALD nonresponding to medical therapy, liver transplantation is the only approach that improves prognosis, and it should be considered in patients with decompensated cirrhosis. […] In the last years, AH has emerged as a new indication of early liver transplantation in non-responders to medical therapy, with promising results in highly selected patients. […] To date, there are no well-validated tools to predict who will develop advanced liver disease secondary to alcohol consumption.

• #35 Alcoholic Hepatitis (Alcohol-Associated Hepatitis): Background, Etiology and Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/170539-overview

  The long-term prognosis of individuals with alcoholic hepatitis depends heavily on whether patients have established cirrhosis and whether they continue to drink. With abstinence, patients with this disease exhibit progressive improvement in liver function over months to years, and the histologic features of active alcoholic hepatitis resolve. If alcohol abuse continues, alcoholic hepatitis invariably persists and progresses to cirrhosis over months to years. In one study, the estimated 5-year survival after hospitalization for severe alcoholic hepatitis was 31.8%. Abstinence was the only independent predictor of long-term survival. […] Annualized rates of progression of precirrhotic disease to cirrhosis are reported to be 1% (0-8%) for patients with normal histology, 3% (2-4%) for hepatic steatosis, 10% (6-17%) for steatohepatitis, and 8% (3-19%) for fibrosis. The annualized mortality for patients with steatosis or cirrhosis is, respectively, 6% (4-7%) and 8% (5-13%). Alcohol-related hepatic steatohepatitis requiring inpatient admission is the most dangerous subtype of alcohol-related liver disease.

• #36 Alcoholic liver disease: A registry view on comorbidities and disease prediction | PLOS Computational Biology

  https://journals.plos.org/ploscompbiol/article?id=10.1371/journal.pcbi.1008244

  We perform a matched casecontrol study using the group of patients with ALC as cases and their matched patients with non-ALD as controls. Machine learning models (SVM, RF, LightGBM and NaiveBayes) trained and tested on the set of ALC patients achieve a high performance for data classification (AUC = 0.89). When testing the same trained models on the small set of ALF patients, their performance unsurprisingly drops a lot (AUC = 0.67 for NaiveBayes). The statistical and machine learning results underscore small groups of upstream and downstream comorbidities that accurately detect ALC patients and show promise in prediction of ALF. […] Unfortunately, people with fibrosis or reversible early-stage cirrhosis of the liver usually are asymptomatic, that is they do not exhibit any symptoms of disease. Most patients are thus only discovered in late stages when complications to ALC cause the healthcare system to suspect liver disease (75% of patients are diagnosed at a late stage, when 5-year survival may be down to 12% [9]). In this context, we present a machine-learning approach for the early detection of fibrosis or cirrhosis in ALD, that enables to identify at-risk patients with ALF and early cirrhosis before they reach the more advanced stage with complications to ALC [10].

• #37 Alcoholic liver disease: A registry view on comorbidities and disease prediction | PLOS Computational Biology

  https://journals.plos.org/ploscompbiol/article?id=10.1371/journal.pcbi.1008244

  We perform a matched casecontrol study using the group of patients with ALC as cases and their matched patients with non-ALD as controls. Machine learning models (SVM, RF, LightGBM and NaiveBayes) trained and tested on the set of ALC patients achieve a high performance for data classification (AUC = 0.89). When testing the same trained models on the small set of ALF patients, their performance unsurprisingly drops a lot (AUC = 0.67 for NaiveBayes). The statistical and machine learning results underscore small groups of upstream and downstream comorbidities that accurately detect ALC patients and show promise in prediction of ALF. […] Unfortunately, people with fibrosis or reversible early-stage cirrhosis of the liver usually are asymptomatic, that is they do not exhibit any symptoms of disease. Most patients are thus only discovered in late stages when complications to ALC cause the healthcare system to suspect liver disease (75% of patients are diagnosed at a late stage, when 5-year survival may be down to 12% [9]). In this context, we present a machine-learning approach for the early detection of fibrosis or cirrhosis in ALD, that enables to identify at-risk patients with ALF and early cirrhosis before they reach the more advanced stage with complications to ALC [10].

• #38 Alcohol-associated liver disease: Epidemiology and management | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-alcohol-associated-liver-disease-epidemiology-management-S166526812300265X

  Alcohol is the leading cause of preventable liver morbidity and mortality worldwide, as it is also the most frequent cause of advanced liver disease. […] Currently, there are no approved targeted therapies able to interfere in the pathogenesis of ALD and halt the progression of the disease, therefore alcohol abstinence is the most effective measure to improve prognosis in this patient population. […] In patients with advanced ALD nonresponding to medical therapy, liver transplantation is the only approach that improves prognosis, and it should be considered in patients with decompensated cirrhosis. […] In the last years, AH has emerged as a new indication of early liver transplantation in non-responders to medical therapy, with promising results in highly selected patients. […] To date, there are no well-validated tools to predict who will develop advanced liver disease secondary to alcohol consumption.

• #39 Alcohol-associated liver disease: Epidemiology and management | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-alcohol-associated-liver-disease-epidemiology-management-S166526812300265X

  Alcohol is the leading cause of preventable liver morbidity and mortality worldwide, as it is also the most frequent cause of advanced liver disease. […] Currently, there are no approved targeted therapies able to interfere in the pathogenesis of ALD and halt the progression of the disease, therefore alcohol abstinence is the most effective measure to improve prognosis in this patient population. […] In patients with advanced ALD nonresponding to medical therapy, liver transplantation is the only approach that improves prognosis, and it should be considered in patients with decompensated cirrhosis. […] In the last years, AH has emerged as a new indication of early liver transplantation in non-responders to medical therapy, with promising results in highly selected patients. […] To date, there are no well-validated tools to predict who will develop advanced liver disease secondary to alcohol consumption.

• #40 Predictive Factors for the Prognosis of Alcoholic Liver Cirrhosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9786187/

  Alcoholic liver cirrhosis (ALC) is a disease with multiple complications and is associated with poor prognosis and significant mortality. Identifying risk factors associated with a poor outcome is important to ensure effective treatment and increase life expectancy. […] The prognosis of the disease was negatively influenced by the worsening of liver dysfunction and the appearance of complications. The main predictors of mortality were infections, hepatic encephalopathy, variceal bleeding, and hepatorenal syndrome. Improving compliance and strict application of specific follow-up and treatment strategies could contribute to a better prognosis of patients with alcoholic liver cirrhosis. […] The independent predictors confirmed by multivariate analysis were the association of variceal bleeding, infections, and hepatic encephalopathy or ascites, each combination being responsible for two out of 10 of the deaths during the first admission.

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