Among Patients with Cirrhosis, Heavy Alcohol Use Is Associated with Decompensated Liver Disease

Alcohol use and hepatitis C virus (HCV) are the two main causes of liver cirrhosis in the US and there is a synergistic relationship between them. However, the relative contribution of each is less clear. In this retrospective study, 122 inpatients who had compensated liver disease were compared with 225 who were decompensated (i.e., had ascites, hepatic encephalopathy, bleeding esophageal varices, or hepatorenal syndrome). The authors investigated the relative impact of viral hepatitis and alcohol use, which was categorized as “heavy” (average of ≥ 6 units* of alcohol in a day), “moderate” (1–6 units in a day), or abstinence.

  • Those with decompensated liver disease were more likely to have heavy alcohol use prior to medical hospital admission (44% versus 19%); this was true for those who had HCV and those who did not.
  • In multivariable analysis, heavy alcohol use was associated with decompensated liver disease (odds ratio [OR], 1.75), while the association with “moderate” alcohol use was not significant (OR, 1.50, CI: 0.43–5.25). HCV was not associated with decompensated liver disease (OR, 1.01).

* Units based on the following conversions: Beer: bottle = 1.5 units, can = 2 units, pint = 3 units; Liquor: shot = 1 unit, bottle = 30 units; Wine: glass = 2 units, bottle = 9 units.


Given the retrospective design and reliance on medical records, one should interpret these results with caution. Moreover, the methods for quantifying alcohol intake were imprecise. However, the main point is that heavy alcohol use is harmful to patients with cirrhosis, regardless of whether they also have HCV or not. The authors conclude that “moderate” alcohol use is not associated with decompensated liver disease, but the point estimate is consistent with an increase in risk.

Darius A. Rastegar, MD


Mankal PK, Abed J, Aristy JD, et al. Relative effects of heavy alcohol use and hepatitis C in decompensated chronic liver disease in a hospital inpatient program. Am J Drug Alcohol Abuse. 2015;41(2):177–182.

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