What determines the prognosis of alcoholic hepatitis?
A: Abstinence from alcohol is the cornerstone of recovery. A promising clinical course in alcoholic hepatitis is largely dictated by abstinence from alcohol, a mild clinical syndrome, and the implementation of appropriate treatment. Within several weeks after discontinuation of alcohol intake, jaundice and fever may resolve, but ascites and hepatic encephalopathy may persist for months to years. Either continued jaundice or the onset of renal failure signifies a poor prognosis. Unfortunately, even when patients adhere to all aspects of medical management, recovery from alcoholic hepatitis is not guaranteed. Up to 40% of patients with severe alcoholic hepatitis die within 6 months after the onset of the clinical syndrome.
What is the risk of liver cirrhosis in patients with chronic excessive alcohol consumption?
A: The association between alcohol intake and alcoholic liver disease has been well documented, although cirrhosis of the liver develops in only a small proportion of heavy drinkers. The risk of cirrhosis increases proportionally with daily consumption of more than 30 g of alcohol per day; the highest risk is associated with daily consumption of more than 120 g per day. The point prevalence of cirrhosis is 1% in persons drinking 30 to 60 g of alcohol a day and up to 5.7% in those consuming 120 g per day. It is presumed that other factors, such as sex, genetic characteristics, and environmental influences (including chronic viral infection such as hepatitis C), play a role in the genesis of alcoholic liver disease.
New England Journal of Medicine - Vol. 360, No. 26, June 25, 2009