Public Release: 

Alcohol use disorders -- stronger predictor of mortality than chronic hepatitis C virus infection

Chronic hepatitis C infection is associated with increased risk of mortality when severe comorbidities and/or alcohol use disorders are also present

European Association for the Study of the Liver

April 25, 2015, Vienna, Austria: Results presented today at The International Liver Congress™ 2015, show that alcohol use disorders (AUD) have a serious, negative prognostic outcome with higher mortality risks in the general population and patients with hepatitis C virus (HCV) infection in particular.

The study found that chronic HCV infection has a limited impact on mortality, unless the patient also has other severe comorbidities, such as HIV infection, cancer or chronic kidney disease. In contrast, those with AUDs are at significant risk of death with a higher mortality risk observed across all the study subgroups.

Michaël Schwarzinger, Director, THEN (Translational Health Economics Network) and Vincent Mallet, Professor of Hepatology, Université Paris Descartes and Assistance Publique -- Hôpitaux de Paris, France, commented: "There is an epidemiological relationship between chronic HCV infection and AUD. However, the burden of chronic HCV infection analyses barely take into account the potential confounding role of AUD on prognosis. Our primary aim was to study the confounding role of severe comorbidities and AUD on prognosis in Hep C patients in a real-life setting."

Between 2008 and 2012, 28,953,755 adults residing in Metropolitan France were hospitalised and 1,506,453 died at hospital. All hospitalised patients were characterised by severe comorbidities and their trajectory was tracked according to chronic HCV infection and/or AUD. Chronic HCV infection was present in 112,146 (0.39%) of hospitalised patients, AUD in 705,259 (2.44%), and both chronic HCV infection and AUD in 23,351 (i.e., 20.8% AUD recorded in Hep C patients).

The researchers found that:

  • Chronic HCV infection was mostly associated with higher mortality risks in the presence of severe comorbidities (e.g., HIV/AIDS, liver transplant receipt)
  • In the absence of severe comorbidities, the prognostic value of chronic HCV infection was mostly explained by the presence of AUD (end-stage liver disease and mortality)
  • More broadly, AUD was associated with higher mortality risks in all hospitalized patients, and alcohol withdrawal or abstinence was significantly associated with lower mortality risks

"These results show that alcohol use disorders are a much more accurate indicator of mortality in chronic HCV infection, and highlight the need to encourage alcohol withdrawal and abstinence in all patients," said Professor Tom Hemming Karlsen, Scientific Committee Member, European Association for the Study of the Liver.

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General session 3, Hall D Presentation time: 09:45-10:00 Presenter: Michaël Schwarzinger (France) Abstract G16: THE COUNFOUNDING ROLE OF SEVERE COMORBIDITIES AND ALCOHOL USE DISORDERS ON PROGNOSIS IN CHRONIC HEPATITIS C VIRUS INFECTION: AN ANALYSIS OF THE 2008-2012 FRENCH NATIONAL HOSPITAL DISCHARGE DATABASE

THE COUNFOUNDING ROLE OF SEVERE COMORBIDITIES AND ALCOHOL USE DISORDERS ON PROGNOSIS IN CHRONIC HEPATITIS C VIRUS INFECTION: AN ANALYSIS OF THE 2008-2012 FRENCH NATIONAL HOSPITAL DISCHARGE DATABASE

Michaël Schwarzinger* 1, Sophie Thiébaut2, Vincent Mallet3, Jürgen Rehm4 1THEN (Translational Health Economics Network), Paris, Canada, 2THEN (Translational Health Economics Network), 3Hepatology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France, 4Social and Epidemiological Research (SER) Department, Centre for Addiction and Mental Health, Toronto, Canada

Background and Aims: There is an epidemiological relationship between chronic hepatitis C virus (HCV) infection and alcohol use disorders (AUD). AUD is a leading cause of liver disease and death. However, burden of chronic HCV infection analyses barely take into account the potential confounding role of AUD on prognosis. Our aim was to compare the prognostic value of chronic HCV infection and AUD in the general population.

Methods: In 2008-2012, 28,953,755 adult individuals residing in Metropolitan France were hospitalized and 1,506,453 died at hospital (51.6% and 55.7% of National Vital Statistics, respectively). We characterized all hospitalized patients by severe comorbidities (see Table), and tracked their trajectory according to chronic HCV infection and/or AUD (including withdrawal/abstinence). Age at death was analyzed in multivariate Cox proportional hazards model from January 2008 to last discharge or transplantation with stratification by gender, main French regions, and having received care in teaching hospitals.

Results: Chronic HCV infection was present in 112,146 (0.39%) of hospitalized patients, AUD in 705,259 (2.44%), both chronic HCV infection and AUD in 23,351(0.08%; i.e., 20.8% of HCV and 3.3% of AUD). Overall, the adjusted hazard ratio of in-hospital death (aHR) was 1.90 (95% confidence interval 1.86-1.94), for chronic HCV infection and 3.13 (3.10-3.15) for AUD, with a negative interaction effect between chronic HCV infection and AUD (aHR, 0.93; 0.90-0.97). Alcohol withdrawal or abstinence was significantly associated with lower mortality risks (HR, 0.66; 0.65-0.67). Subgroup analyses by severe comorbidities revealed that chronic HCV infection was only associated with higher mortality risks in presence of severe comorbidities (Table: groups 1 to 4, and 7 to 12). In absence of severe comorbidities, the prognostic value of chronic HCV infection at all liver disease stages was either not statistically significant among patients with cirrhosis and milder liver disease stage (groups 13 to 17). In contrast, AUD was associated with higher mortality risks in all prognostic subgroups, including all liver disease stages.

Conclusions: AUD has a dismal prognostic value in the general population and in the minority group of patients with chronic HCV infection. Alcohol withdrawal and abstinence increase survival regardless of HCV treatment.

Disclosure of Interest: None Declared

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