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

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).

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.

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.

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