title: Relative effects of heavy alcohol use and hepatitis C in decompensated chronic liver disease in a hospital inpatient population.
abstract: BACKGROUND
  Heavy alcohol use has been hypothesized to accelerate disease progression to end-stage liver disease in patients with hepatitis C virus (HCV) infection. In this study, we estimated the relative influences of heavy alcohol use and HCV in decompensated chronic liver disease (CLD).
  
  
  METHODS
  Retrospectively, 904 patients with cirrhotic disease admitted to our hospitals during January 2010-December 2012 were identified based on ICD9 codes. A thorough chart review captured information on demographics, viral hepatitis status, alcohol use and progression of liver disease (i.e. decompensation). Decompensation was defined as the presence of ascites due to portal hypertension, bleeding esophageal varices, hepatic encephalopathy or hepatorenal syndrome. Heavy alcohol use was defined as a chart entry of greater than six daily units of alcohol or its equivalent.
  
  
  RESULTS
  347 patients were included based on our selection criteria of documented heavy alcohol use (n = 215; 62.0%), hepatitis titers (HCV: n = 182; 52.5%) and radiological evidence of CLD with or without decompensation (decompensation: n = 225; 64.8%). Independent of HCV infection, heavy alcohol use significantly increased the risk of decompensation (OR = 1.75, 95% CI 1.11-2.75, p < 0.02) relative to no heavy alcohol use. No significance was seen with age, sex, race, HIV, viral hepatitis and moderate alcohol use for risk for decompensation. Additionally, dose-relationship regression analysis revealed that heavy, but not moderate alcohol use, resulted in a three-fold increase (p = 0.013) in the risk of decompensation relative to abstinence.
  
  
  CONCLUSIONS
  While both heavy alcohol use and HCV infection are associated with risk of developing CLD, our data suggest that heavy, but not moderate, alcohol consumption is associated with a greater risk for hepatic decompensation in patients with cirrhosis than does HCV infection.
authors.affiliation: Department of Medicine and.
authors.forename: Pavan Kumar
authors.initials: PK
authors.lastname: Mankal
authors.forename: Jean
authors.initials: J
authors.lastname: Abed
authors.forename: Jose David
authors.initials: JD
authors.lastname: Aristy
authors.forename: Khushboo
authors.initials: K
authors.lastname: Munot
authors.forename: Upma
authors.initials: U
authors.lastname: Suneja
authors.forename: Ellen S
authors.initials: ES
authors.lastname: Engelson
authors.forename: Donald P
authors.initials: DP
authors.lastname: Kotler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000150:complications* / Q000473:pathology; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D006501:Hepatic Encephalopathy / Q000150:complications* / Q000473:pathology; D006526:Hepatitis C / Q000150:complications* / Q000473:pathology; D006801:Humans; D007297:Inpatients; D017093:Liver Failure / Q000150:complications* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Alcohol; ascites; cirrhosis; end stage liver disease; varices