Recurrent alcohol-associated hepatitis is common and is associated with increased mortality

Abstract

Background:Alcohol relapse after surviving an episode of alcohol-associated hepatitis (AH) is common. However, the clinical features, risk factors and prognostic implications of recurrent AH (RAH) are not well described. Methods:A registry-based study of patients admitted to 28 Spanish hospitals for an episode of AH between 2014 and 2021. Baseline demographics and laboratory variables were collected. Risk factors for RAH were investigated using Cox regression analysis. We analyzed the severity of the index episodes of AH and compared it to that of RAH. Long-term survival was assessed by Kaplan-Meier curves and log-rank test. Results:A total of 1,118 patients were included in the analysis, 125 (11%) of whom developed RAH during follow-up (median: 17 [7-36] months). The incidence of RAH in patients resuming alcohol use was 22%. Median time to recurrence was 14 (8-29) months. Patients with RAH had more psychiatric comorbidities. Risk factors for developing RAH included age <50 years, alcohol use >10 units/day and history of liver decompensation. RAH was clinically more severe compared to first AH (higher MELD, more frequent ACLF and hepatic encephalopathy). Moreover, alcohol abstinence during follow-up was less common after RAH (18% vs 45%, p<0.001). Most importantly, long-term mortality was higher in patients who developed RAH (39% vs 21%, p=0.026) and presenting with RAH independently predicted high mortality (HR 1.55 [1.11-2.18]). Conclusions:RAH is common and has a more aggressive clinical course, including increased mortality. Patients surviving an episode of AH should undergo intense alcohol use disorder therapy to prevent RAH.