title: Clinical but not histological factors predict long-term prognosis in patients with histologically advanced non-decompensated alcoholic liver disease.
abstract: BACKGROUND
  Alcoholic liver disease (ALD) is a significant threat to public health and a leading cause of death. Despite this, the long-term clinical course and predictive factors of survival in histologically advanced ALD are not well described.
  
  
  OBJECTIVE
  The aim of this study was to identify clinical and histological factors that predict long-term (15-year) survival in outpatients with histologically advanced non-decompensated ALD.
  
  
  METHODS
  Patients (n = 134) with biopsy-proven histologically advanced (stage III or IV) ALD were followed up for 15 years or until death or orthotopic liver transplantation. At baseline, clinical and laboratory data were collected. On biopsy, the degree of fibrosis as well as other histological features (fat type and severity, lymphocyte and neutrophil infiltration) were scored semiquantitatively.
  
  
  RESULTS
  Most patients were male (72%) with a median age 51 (46-57). Overall, the 5-, 10- and 15-year survival was 63, 36 and 24% respectively. In multivariate analysis, persistent drinking (P = 0.01), smoking (P = 0.03), age (P = 0.01) and serum albumin at baseline (P = 0.001) were associated with significantly increased risk of death. Persistent drinking was associated with the highest risk. No histological features, including whether the stage of ALD was bridging fibrosis or cirrhosis, correlated with prognosis.
  
  
  CONCLUSIONS
  In outpatients with biopsy-proven histologically advanced non-decompensated ALD, clinical but not histological factors determine prognosis. Persistent alcohol intake is the strongest predictor and smoking habit, age and serum albumin are also independently prognostic. Abstinence from alcohol and smoking cessation should be the priorities in the long-term management of ALD.
authors.affiliation: Liver Transplant Unit, Freeman Hospital, Newcastle, UK; Institute of Cellular Medicine, Newcastle University Medical School, Newcastle, UK.
authors.forename: Steven
authors.initials: S
authors.lastname: Masson
authors.forename: Ingrid
authors.initials: I
authors.lastname: Emmerson
authors.forename: Elsbeth
authors.initials: E
authors.lastname: Henderson
authors.forename: Emma H
authors.initials: EH
authors.lastname: Fletcher
authors.forename: Alastair D
authors.initials: AD
authors.lastname: Burt
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Day
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Stewart
mesh_terms: D000273:Adipose Tissue / Q000473:pathology*; D000428:Alcohol Drinking / Q000009:adverse effects*; D004739:England; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000473:pathology; D008108:Liver Diseases, Alcoholic / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020556:Neutrophil Infiltration / Q000502:physiology; D011379:Prognosis; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects*; D015996:Survival Rate
chemical_list: D012709:Serum Albumin
keywords: alcoholic liver disease; cirrhosis; fibrosis; prognosis; survival