Short-term and long-term causes of death in patients with alcoholic hepatitis in Denmark

The incidence of acute alcoholic hepatitis is increasing, and mortality is high. However, causes of death among patients with alcoholic hepatitis have not been systematically recorded. We investigated causes of death in a population-based cohort of patients with alcoholic hepatitis who were followed for as long as 10 years.

We used the Danish National Registry of Patients to identify all patients with a first-time episode of alcoholic hepatitis from 1999 through 2008. We collected and analyzed data on 1951 patients, identifying causes of death, diagnoses of cirrhosis, and alcohol abuse.

Of the 1951 patients, 401 died within the first 84 days after admission, and 600 died later (through December 31, 2008). Most deaths within the first 84 days after admission resulted from liver failure (40%), infections (20%), or hepatorenal syndrome (11%). Beyond 84 days, causes of deaths differed between patients with and without cirrhosis; most patients without cirrhosis (n = 326) died of causes related to alcohol abuse, whereas most patients with cirrhosis (n = 675) died of liver failure (34%), infections (16%), or variceal bleeding (11%). Cirrhosis was present in 51% of patients diagnosed with alcoholic hepatitis. Among patients without cirrhosis, 24% developed cirrhosis within 10 years; continued alcohol abuse was a strong risk factor for cirrhosis (hazard ratio, 2.14; 95% confidence interval, 1.50-3.05). The 10-year risk of a second episode of alcoholic hepatitis was 12%.

On the basis of a study of the Danish population, the most common causes of death among patients with alcoholic hepatitis, within 84 days and within 10 years, are liver-related events and infections. Strategies are to identify and treat these complications and to reduce alcoholism.