Alcoholic liver disease natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: M. Khurram Afzal, MD [2]

Overview

Alcoholic liver disease progresses through three stages (steatosis, alcoholic hepatitis, and cirrhosis) with the continued use of alcohol. Serious complications begin to occur with the development of alcoholic hepatitis, when portal hypertension, coagulopathies, and intractable jaundice. Complications of cirrhosis include hepatic encephalopathy and hepatocellular carcinoma. Prognosis varies dependent on level of progression of illness, and whether treatment is given. Prognosis can be measured using laboratory values, and three prognostic scores: The MELD score, the Glasgow Alcoholic Hepatitis Score, and the ABIC score.

Natural History

Significant aspects regarding natural history of alcoholic liver disease include:[1][2][3]

Complications

Alcoholic hepatitis

Complications of alcoholic hepatitis include:[2][3][4][5][6][7]

Cirrhosis

Complications of cirrhosis include:[2][3][4][5][6][7]

Prognosis

Poor Prognostic Factors

Poor prognostic factors of alcoholic liver disease include:[4][5][8]

Prognostic Scores

Prognostic scores used to assess the prognosis of patients with alcoholic liver disease include:[4][5][8]

2010 AASLD/ACG Alcoholic Liver Disease Guidelines (DO NOT EDIT)[9]

Prognostic factors : Guidelines (DO NOT EDIT)[9]

Class I
1. " Patients presenting with a high clinical suspicion of alcoholic hepatitis should have their risk for poor outcome stratified using the Maddrey Discriminant Function (MDF), as well as other available clinical data. Evaluating a patient's condition over time with serial calculation of the Model for End-Stage Liver Disease (MELD) score is also justified. (Level of evidence: B) "

References

  1. Ceni E, Mello T, Galli A (2014). "Pathogenesis of alcoholic liver disease: role of oxidative metabolism". World J. Gastroenterol. 20 (47): 17756–72. PMC 4273126Freely accessible. PMID 25548474. doi:10.3748/wjg.v20.i47.17756. 
  2. 2.0 2.1 2.2 Mathurin P, Bataller R (2015). "Trends in the management and burden of alcoholic liver disease". J. Hepatol. 62 (1 Suppl): S38–46. PMC 5013530Freely accessible. PMID 25920088. doi:10.1016/j.jhep.2015.03.006. 
  3. 3.0 3.1 3.2 Lucey MR, Mathurin P, Morgan TR (2009). "Alcoholic hepatitis". N. Engl. J. Med. 360 (26): 2758–69. PMID 19553649. doi:10.1056/NEJMra0805786. 
  4. 4.0 4.1 4.2 4.3 Allampati S, Mullen KD (2016). "Long-Term Management of Alcoholic Liver Disease". Clin Liver Dis. 20 (3): 551–62. PMID 27373616. doi:10.1016/j.cld.2016.02.011. 
  5. 5.0 5.1 5.2 5.3 O'Shea RS, Dasarathy S, McCullough AJ (2010). "Alcoholic liver disease". Hepatology. 51 (1): 307–28. PMID 20034030. doi:10.1002/hep.23258. 
  6. 6.0 6.1 Adachi M, Brenner DA (2005). "Clinical syndromes of alcoholic liver disease". Dig Dis. 23 (3-4): 255–63. PMID 16508290. doi:10.1159/000090173. 
  7. 7.0 7.1 Gaglio PJ, Gaglio PJ (2012). "Complications in patients with alcohol-associated liver disease who undergo liver transplantation". Clin Liver Dis. 16 (4): 865–75. PMID 23101987. doi:10.1016/j.cld.2012.08.013. 
  8. 8.0 8.1 Torruellas C, French SW, Medici V (2014). "Diagnosis of alcoholic liver disease". World J. Gastroenterol. 20 (33): 11684–99. PMC 4155359Freely accessible. PMID 25206273. doi:10.3748/wjg.v20.i33.11684. 
  9. 9.0 9.1 "www.aasld.org" (PDF). Retrieved 2012-10-27. 



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