Recompensation in Patients With Alcohol-Related Liver Disease—A Multicenter Study

Abstract

Background and Aims

Removal of etiology of cirrhosis may lead to recompensation in decompensated cirrhosis. Few studies have reported on rates of recompensation, as per Baveno VII criteria, in viral etiology-related decompensated cirrhosis. Our aim was to assess the rate and predictors of recompensation in the spectrum of alcohol-related liver disease (ALD).

Methods

Retrospective multicenter cohort study across 5 Indian centers included patients with a spectrum of ALD from January 2018 to November 2024. Clinical and biochemical data were collected and patients followed, and end points of recompensation, mortality, and transplant-free survival were evaluated.

Results

Among 344 patients (age: 41.2 ± 8.4 years; Model for End-Stage Liver Disease: 23.9 ± 6.2; men: 98.3%), 242 had decompensated cirrhosis with alcohol-associated hepatitis (DC + AAH), and 102 had decompensated cirrhosis without alcohol-associated hepatitis (DC-AAH). Twenty percent (69/344) achieved recompensation as per Baveno VII criteria over 21 (range, 12–67) months. The recompensation rate was higher among those with DC-AAH (30.4%; 31/102) compared to DC + AAH (15.7%; 38/242; P = .002). Transplant-free survival was higher among those who recompensated (DC + AAH: 92.1% vs 77.9%; DC-AAH: 93.5% vs 76.1%). On competing risk regression analysis, duration of abstinence (subdistribution hazard ratio, 1.03 [95% confidence interval, 1.01–1.05]; P = .04) and Child score (subdistribution hazard ratio 0.83 [95% confidence interval, 0.71–0.98]; P = .03) predicted recompensation. Model for End-Stage Liver Disease (hazard ratio, 1.09 [1.09–1.16]; P = .001) and recompensation (hazard ratio, 0.14 [0.04–0.49]; P = .002) predicted mortality.

Conclusion

Twenty percent of patients in the spectrum of ALD demonstrated recompensation, which was associated with improved survival.