Alcohol consumption is associated with the severity and outcome of acute liver injury/failure

Abstract

Background & AimsNonâ medical factors which contribute to the severity of acute liver failure (ALF) remain poorly defined. The association of alcohol consumption on the severity of presentation and outcome were determined in patients with ALF and acute liver injury (ALI) in a large, multicentre registry.MethodsAlcohol consumption during the 6Â months prior to study entry was analysed in 1170 patients enrolled in the ALF Study Group Registry. Consumption was categorized as none/minimal (<3 alcoholic beverages/week) or at least moderate (â ¥3/week). Clinical characteristics, the severity of liver injury at presentation (ALI or ALF) and outcome were compared.ResultsIn patients with acetaminophen (APAP) overdose, at least moderate alcohol consumption was associated with higher peak aminotransferases, bilirubin, creatinine and INR on admission, compared to no/minimal consumption. In patients with nonâ APAP ALI/ALF, at least moderate alcohol consumption was associated with higher peak aminotransferases and creatinine. In APAP, nonâ APAP or all aetiologies, at least moderate alcohol consumption was associated with a 75%, 89% and 82% higher odds, respectively, of presenting as ALF rather than ALI (all PÂ <Â .005). At least moderate alcohol consumption increased the odds of death by 45% (PÂ =Â .01) across all aetiologies. In multivariate analysis, older age, nonâ Caucasian race, peak INR, peak bilirubin and at least moderate alcohol consumption were significantly associated with death. Finally, in Kaplanâ Meier analysis of patients with all aetiologies, at least moderate alcohol consumption was associated with decreased timeâ dependent survival (PÂ =Â .002).ConclusionAlcohol consumption adversely affects the presentation and outcome of both APAPâ and nonâ APAPâ induced ALI/ALF.