Alcohol consumption by cirrhotic subjects: patterns of use and effects on liver function.
OBJECTIVE
We investigated patterns of use of alcohol and its clinical effects among cirrhotic subjects who participated in a randomized clinical trial comparing the efficacy of transjugular intravenous portosystemic shunt and distal splenorenal shunt.


METHODS
There were 132 cirrhotic subjects, 78 with alcoholic liver disease (ALD), who were followed for a median of 49 months (range 2-93 months). Alcohol use was assessed by patient questionnaire, with corroboration by family members.


RESULTS
Twenty-eight subjects (21%) were drinking at study entry and 60 subjects (45%) drank during follow-up. Heavy drinking (>4 drinks/day) was recorded in 25 ALD subjects, but in no non-ALD subjects (P < 0.0001). Drinking by ALD subjects was associated with a 153% increase in gamma-glutamyl transpeptidase (GGT) (P < 0.0001). The frequencies of death (46%vs 30%), ascites (33%vs 20%), encephalopathy (56%vs 42%), and variceal bleeding (11%vs 3%) were greater in the ALD group. In a Cox proportional hazards model only "ever heavy drinking" was associated with death (P= 0.0099), while recent heavy drinking increased the hazard of variceal hemorrhage dramatically (odds ratio 10.85).


CONCLUSIONS
Whereas most cirrhotic subjects, alcoholic or not, did not drink during 5 yr of observation, heavy alcohol use occurred exclusively in ALD patients. Alcohol use by ALD subjects was associated with elevations in GGT and was linked to death and with rebleeding from shunt dysfunction.
Lucey
Michael R
MR
Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53792-5124, USA.
Connor
Jason T
JT
Boyer
Thomas D
TD
Henderson
J Michael
JM
Rikkers
Layton F
LF
D000428:Alcohol Drinking / Q000401:mortality; D001201:Ascites / Q000209:etiology; D004932:Esophageal and Gastric Varices / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000150:complications; D006501:Hepatic Encephalopathy / Q000209:etiology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000201:enzymology / Q000401:mortality / Q000503:physiopathology; D008104:Liver Cirrhosis, Alcoholic / Q000201:enzymology / Q000401:mortality / Q000503:physiopathology*; D008108:Liver Diseases, Alcoholic / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D005723:gamma-Glutamyltransferase / Q000097:blood
D005723:gamma-Glutamyltransferase