Alcoholic Hepatitis: Predicting Life Expectancy

Acute alcoholic hepatitis is a serious and life-threatening condition that can lead to permanent liver damage, liver failure, cancer, or death. It is caused by heavy alcohol consumption and is characterised by jaundice, fever, tachycardia, tachypnea, hepatomegaly, leukocytosis with neutrophilia, and elevated liver enzymes. The life expectancy of patients with acute alcoholic hepatitis depends on several factors, including the severity of the condition, the presence of liver cirrhosis, the patient's age, and their response to treatment. Treatment options include steroids, nutritional supplementation, and liver transplantation, with complete abstinence from alcohol being crucial for improving life expectancy.

The Glasgow Alcoholic Hepatitis Score (GAHS)

Alcoholic hepatitis is a serious and life-threatening illness that claims the lives of many people in the UK each year. It is caused by heavy alcohol consumption over an extended period, although some people are more sensitive to alcohol and their livers react to even moderate use. Acute alcoholic hepatitis might only be a temporary response to overindulgence, but when it becomes chronic, it can cause permanent liver damage.

The GAHS has been validated in a cohort of 195 patients from across the United Kingdom, none of whom had received corticosteroids, pentoxifylline, or anti-tumour necrosis factor treatment. The score was found to be more accurate in predicting outcomes at 28 and 84 days after admission when compared to the modified Maddrey's discriminant function (mDF). The mDF is another scoring system used to assess the severity of alcoholic hepatitis, with a score of 32 or above indicating a higher risk of mortality. However, the GAHS has been shown to be more accurate than the mDF in predicting outcomes for patients with severe alcoholic hepatitis.

While the GAHS is a useful tool for assessing the severity of alcoholic hepatitis and predicting patient outcomes, it is important to note that there is no consensus on the pharmacological treatment of alcoholic hepatitis. The decision to treat with corticosteroids or other medications should be made on a case-by-case basis, taking into account the patient's individual circumstances and medical history. Additionally, it is worth noting that the most effective way to prevent alcoholic hepatitis and improve life expectancy is to reduce or stop alcohol consumption.

The Lille model

It is important to note that acute alcoholic hepatitis is a serious and life-threatening condition. Alcoholic liver disease is a common diagnosis among patients requiring liver transplants, and death rates linked to alcohol-related liver disease have risen significantly in recent decades. The most effective way to prevent and treat alcoholic liver disease is to stop drinking alcohol or stick to recommended limits.

The ABIC score

While these scoring models provide valuable prognostic information, it is important to note that the management of acute alcoholic hepatitis focuses on treating the underlying cause, which is often alcohol abuse or heavy alcohol consumption. Abstinence from alcohol is crucial for improving life expectancy and preventing further liver damage. Support, advice, and medical treatment may be available through local alcohol addiction support services.

Additionally, in severe cases of acute alcoholic hepatitis, liver transplantation may be considered. However, most transplant programmes require a period of abstinence from alcohol prior to transplantation, typically for six months.

The benefits of quitting alcohol

Alcoholic liver disease (ALD) is a spectrum of diseases ranging from steatosis, steatohepatitis, fibrosis, and cirrhosis to hepatocellular carcinoma. Alcohol-induced hepatitis might only be a temporary response to overindulgence, but when it becomes chronic, it can lead to permanent liver damage. The most effective way to prevent ALD is to stop drinking alcohol or stick to the recommended limits.

Quitting alcohol can be challenging, especially if it has been a significant part of one's life. However, the benefits of abstinence are significant and far-reaching. Here are some of the advantages of giving up alcohol:

Improved Physical Health

Alcohol affects the liver, brain, heart, and gut. Quitting alcohol allows the body to heal, and some of the damage can be reversed. Alcohol withdrawal can lead to better sleep quality, improved hydration, reduced blood pressure, and lower disease risk. The liver, which filters alcohol, can regenerate and recover. The brain function improves, and the risk of mental health issues decreases. The heart benefits from reduced stroke and heart disease risk, and the gut heals from inflammation, improving digestion and nutrition absorption.

Enhanced Mental Health and Wellbeing

Alcohol affects mood, behaviour, coordination, and memory. Quitting alcohol improves mental well-being and may lower the risk of mental health issues such as anxiety and depression. It also helps restore the skin's elasticity and reduces redness and discolouration.

Financial Savings and Weight Management

Alcohol is costly, and quitting can result in significant financial savings. Additionally, alcohol is high in calories and can contribute to weight gain. Giving up alcohol can aid in weight management and improve overall health.

Social and Relational Benefits

Alcohol often plays a role in social activities and hobbies. Quitting alcohol may lead to developing new, non-alcohol-related pastimes and improving relationships.

The risks of alcohol withdrawal

While quitting alcohol can improve acute alcoholic hepatitis and prevent further damage to the liver, the process of alcohol withdrawal can be challenging and risky. The risks associated with alcohol withdrawal vary from person to person and are influenced by several factors. Here are some key considerations regarding the risks of alcohol withdrawal:

• Severity of Alcohol Use: The severity of a person's alcohol consumption plays a significant role in the risks they face during withdrawal. Heavy and prolonged alcohol use increases the likelihood of experiencing more severe withdrawal symptoms. This includes individuals who have been drinking excessively for years or those who engage in binge drinking, which is typically defined as consuming more than five drinks in a night for men or four for women.
• Previous Detoxifications: Individuals who have undergone multiple detoxification cycles are at a higher risk of dangerous withdrawal symptoms. Each cycle of detoxification and relapse can increase the severity of withdrawal symptoms during subsequent attempts to quit.
• Seizures and Delirium Tremens (DTs): Withdrawal seizures can occur as early as 2 hours after stopping alcohol consumption, but they typically happen between 24 and 48 hours. Delirium tremens, a life-threatening condition characterized by confusion, restlessness, fever, and seizures, usually begins between 48 and 72 hours after the last drink. People with a history of withdrawal seizures or those who have undergone multiple detoxifications are at a higher risk of developing DTs.
• Medical Conditions: Individuals with acute medical illnesses, abnormal liver function, or older age are more susceptible to severe withdrawal symptoms, including DTs. Co-occurring medical problems, such as altered blood chemistry, certain infections, or Wernicke's syndrome, can further complicate the withdrawal process and worsen outcomes.
• Mental Health: Alcohol withdrawal can trigger or exacerbate mental health issues such as depression, anxiety, and sleep disturbances. Individuals with clinically diagnosed depression may experience depressive symptoms during withdrawal, and the risk of suicide is also elevated among alcoholics. Treating mental health issues during rehabilitation is crucial to reducing the risk of relapse.
• Individual Variations: It is important to recognize that everyone's experience with alcohol withdrawal is unique. Factors such as genetic differences, sex, and individual tolerance can influence the severity of withdrawal symptoms. Some people may be more sensitive to alcohol, while others can consume larger amounts without inducing hepatitis.

Given these risks, it is essential to seek professional support and medical advice when considering alcohol withdrawal, especially for those with severe alcohol use disorders or co-occurring medical and mental health conditions. Medically managed detox programs can help monitor and manage withdrawal symptoms, reducing the risks associated with alcohol withdrawal.

Frequently asked questions