The prevalence of alcohol-induced liver disease and hepatitis C and their interaction in a tertiary care setting.
OBJECTIVE
We examined the prevalence and clinical characteristics of alcohol-induced liver disease (ALD) in patients referred to a tertiary care center and examined the interaction between ALD and hepatitis C virus (HCV) in a longitudinal survival model.


METHODS
A total of 1611 patients with chronic liver disease referred to a tertiary care center between 1994 and 2001 were analyzed. The survival of ALD, HCV, and the combination of the 2 (ALD + HCV) was compared in cirrhotic and precirrhotic patients by using Kaplan-Meier estimates. A Cox proportional hazards model was used to examine the independent effects of predictors on survival.


RESULTS
ALD comprised 31% of the cohort, ALD + HCV comprised 14%, HCV comprised 22%, and the rest comprised 33%. The survival of precirrhotic patients with HCV was significantly better than the survival of those with ALD (hazard ratio, 0.27; P = 0.0006) over long-term and 1-year (hazard ratio, 0.24; P = 0.016) follow-up periods. There was no difference in survival between patients with ALD and ALD + HCV ( P = 0.62). In patients with cirrhosis, survival did not differ by cause; decompensated liver disease (hazard ratio, 1.67; P = 0.004) and continued alcohol abuse (hazard ratio, 2.19; P = 0.002) predicted worse survival in this group.


CONCLUSIONS
ALD with HCV remains a prevalent cause of chronic liver disease in patients referred to a U.S. tertiary care center. In patients with ALD, the addition of HCV does not change survival, suggesting alcoholism is the driving force for mortality in patients coming to clinical attention. In patients with cirrhosis, ongoing excessive alcohol use and complications of end-stage liver disease drive mortality, irrespective of the underlying cause of chronic liver disease.
Said
Adnan
A
Section of Gastroenterology and Hepatology, Deparment of Medicine, University of Wisconsin, Madison, Wisconsin 53792, USA.
Williams
John
J
Holden
Jeremy
J
Remington
Patrick
P
Musat
Alexandru
A
Lucey
Michael R
MR
D000367:Age Factors; D000437:Alcoholism / Q000453:epidemiology; D000998:Antiviral Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006526:Hepatitis C / Q000150:complications / Q000401:mortality* / Q000628:therapy; D006801:Humans; D008108:Liver Diseases, Alcoholic / Q000150:complications / Q000401:mortality* / Q000601:surgery; D008113:Liver Neoplasms / Q000453:epidemiology; D016031:Liver Transplantation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012907:Smoking / Q000453:epidemiology; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology
D000998:Antiviral Agents