Prevalence and Outcomes of Recurrent Alcohol-associated Hepatitis

Alcohol-associated hepatitis (AH) is a life-threatening complication of heavy alcohol use; recurrent alcohol-associated hepatitis (RAH) is when AH returns following a period of recovery. This study examined the prevalence of RAH and related clinical outcomes among 1118 patients from 28 Spanish hospitals who had an initial diagnosis of AH from 2014 to 2021.

• Among the 51 percent of patients who resumed alcohol consumption during follow-up for AH, 22 percent developed RAH; 100 percent of those who developed RAH had resumed alcohol consumption. Of those who survived RAH, 81 percent subsequently resumed alcohol consumption.
• Independent risk factors for RAH were higher baseline alcohol consumption, age <50 years, and a history of hepatic decompensation.
• Compared with patients with AH, those with RAH had lower platelet levels, decreased liver function, higher incidences of acute-on-chronic liver failure and hepatic encephalopathy, and higher rates of mortality (39 percent versus 21 percent).

Comments: After an initial diagnosis of AH, a substantial fraction of patients who continue to drink will develop RAH. RAH is more clinically severe than AH, with a significantly increased risk of death compared with the initial episode. Addressing alcohol use disorder, including through specialty treatment and/or medication, is the cornerstone of prevention and management of AH and RAH, and is especially vital for those who continue alcohol use after their first course of AH. Intervention for these patients may also increase eligibility for liver transplantation among those who develop liver failure.

Alyse Nelson* & Timothy S. Naimi, MD, MPH

* Contributing Editorial Intern & Grayken Women’s Health Initiative MSW Intern, Boston Medical Center

Reference: Gratacós-Ginès J, Ruz-Zafra P, Celada-Sendino M, et al. Recurrent alcohol-associated hepatitis is common and is associated with increased mortality. Hepatology. 2024;80(3):621–632.