Alcohol-related liver disease phenotype impacts survival after an acute variceal bleeding episode

Ares Villagrasa, Virginia Hernández-Gea, Ramon Bataller, Álvaro Giráldez, Bogdan Procopet, Lucio Amitrano, Candid Villanueva, Dominique Thabut, Luis Ibañez-Samaniego, Agustin Albillos, Christophe Bureau, Jonel Trebicka, Elba Llop, Wim Laleman, J. M. Palazon, Jose Castellote, Susana Rodrigues, Lise L. Gluud, Carlos N. Ferreira, Nuria CañeteManuel Rodríguez, Arnulf Ferlitsch, Jose L. Mundi, Henning Gronbaek, Manuel Hernández-Guerra, Romano Sassatelli, Alessandra Dell'Era, Marco Senzolo, Juan G. Abraldes, Alexander Zipprich, Meritxell Casas, Helena Masnou, Massimo Primignani, Aleksander Krag, Gilberto Silva-Junior, Manuel Romero-Gómez, Marcel Tantau, Maria A. Guardascione, Edilmar Alvarado, Marika Rudler, Rafael Bañares, Javier Martinez, Marie A. Robic, Christian Jansen, Jose L. Calleja, Frederik Nevens, Jaime Bosch, Meritxell Ventura-Cots*, Juan C. García-Pagan, Joan Genescà, for the International Variceal Bleeding Observational Study Group; Baveno Cooperation

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review


Background & Aims: Alcohol-related hepatitis (AH) encompasses a high mortality. AH might be a concomitant event in patients with acute variceal bleeding (AVB). The current study aimed to assess the prevalence of AH in patients with AVB and to compare the clinical outcomes of AH patients to other alcohol-related liver disease (ALD) phenotypes and viral cirrhosis. Methods: Multicentre, observational study including 916 patients with AVB falling under the next categories: AH (n = 99), ALD cirrhosis actively drinking (d-ALD) (n = 285), ALD cirrhosis abstinent from alcohol (a-ALD) (n = 227) and viral cirrhosis (n = 305). We used a Cox proportional hazards model to calculate adjusted hazard ratio (HR) of death adjusted by MELD. Results: The prevalence of AH was 16% considering only ALD patients. AH patients exhibited more complications. Forty-two days transplant-free survival was worse among AH, but statistical differences were only observed between AH and d-ALD groups (84 vs. 93%; p = 0.005), when adjusted by MELD no differences were observed between AH and the other groups. At one-year, survival of AH patients (72.7%) was similar to the other groups; when adjusted by MELD mortality HR was better in AH compared to a-ALD (0.48; 0.29–0.8, p = 0.004). Finally, active drinkers who remained abstinent presented better survival, independently of having AH. Conclusions: Contrary to expected, AH patients with AVB present no worse one-year survival than other patients with different alcohol-related phenotypes or viral cirrhosis. Abstinence influences long-term survival and could explain these counterintuitive results.

Original languageEnglish
JournalLiver International
Issue number7
Pages (from-to)1548-1557
Publication statusPublished - Jul 2023


  • abstinence
  • alcohol
  • alcohol-related hepatitis
  • cirrhosis
  • upper gastrointestinal bleeding


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