Prognosis
Natural history
It is important to emphasise that the signs, symptoms, histological stages, and severity of liver disease are variable among people with ARLD. In addition, relatively asymptomatic patients may have histologically advanced liver disease. Clinical decompensation carries a poor prognosis regardless of the histological stage of ARLD.
Steatosis may result from acute alcohol misuse. In long-term heavy alcohol consumers, about 90% to 100% develop steatosis, 20% to 35% develop alcohol-related hepatitis, and 8% to 20% develop alcohol-related cirrhosis. Cirrhosis from severe and prolonged liver damage used to be considered an irreversible outcome. However, studies in patients with liver disease have shown some degree of reversibility. The 5-year survival rate for people with cirrhosis who stop drinking is about 90%, compared with 70% of those who do not stop drinking. However, for late-stage cirrhosis (e.g., jaundice, ascites, or gastrointestinal bleeding), the survival rate is only 60% for those who stop drinking and 35% for those who do not.[153] For those patients with decompensated alcohol-related cirrhosis who undergo liver transplantation, 5-year survival is about 70%.
Predictive models
Maddrey discriminant function (MDF) and model for end-stage liver disease (MELD)
MDF is a model based on a composite scoring of prothrombin time (PT) and total bilirubin. A higher score indicates a worse prognosis. MDF score >32 indicates high mortality of around 35% to 45%.[107][154] Patients with MDF score <32 have short-term survival rates of 90% to 100%. [ Modified Maddrey's Discriminant Function Opens in new window ]
The 30-day mortality in patients with alcohol-related hepatitis ranges from 0% to 50%.[107] Both the MDF score and the model for end-stage liver disease (MELD) score can be used to predict short-term mortality in patients with alcohol-related hepatitis.[155] A MELD score of ≤20 indicates moderate alcohol-related hepatitis, while a MELD score of >20 indicates severe alcohol-related hepatitis.[1] Three-year survival approaches 90% in abstainers, whereas it is <70% in active drinkers.[154] [ MELDNa scores (for liver transplantation listing purposes, not appropriate for patients under age 12 years) (SI units) Opens in new window ]
Glasgow alcoholic hepatitis score (GAHS)
GAHS is based on a composite scoring of age, serum urea (mmol/L), serum bilirubin (mmol/L), PT, and WBC count. A higher score indicates a worse prognosis. GAHS score on day 1 had an overall accuracy of 81% when predicting 28-day outcome in patients with alcohol-related hepatitis.[156]
Lille model
The Lille model is based on a composite scoring of age, serum albumin (g/L), serum creatinine above or below 99.13 micromol/L (1.3 mg/dL), bilirubin, change in bilirubin from day 0 to day 7, and PT. A score of >0.45 predicts a 6-month survival of 25%, versus 85% survival when the score is <0.45.[110]
Child-Turcotte-Pugh index
The Child-Turcotte-Pugh index includes a combination of clinical and laboratory variables and can be useful to assess disease severity and set a baseline for future reference. [ Child Pugh classification for severity of liver disease (SI units) Opens in new window ]
Use of this content is subject to our disclaimer