ArticleJHEP reports : innovation in hepatology2024
Infections increase the risk of decompensation and death in patients with early alcohol-related liver disease.
Article in JHEP reports : innovation in hepatology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it, 6 citations in OpenAlex.
- Global prevalence of metabolic dysfunction-associated fatty liver disease in children and adolescents with overweight and obesity: a systematic review and meta-analysis.BMC gastroenterology · 2025Pooled it
- Incidence and Mortality of Community-Acquired Sepsis or Bacteraemia in Patients With Alcohol-Related Cirrhosis.Liver international : official journal of the International Association for the Study of the Liver · 2026Article
- Association of a Reported Penicillin Allergy Label With Clinical Outcomes in Alcohol-Associated Liver Disease.Alcohol, clinical & experimental research · 2026Article
- FLASH radiotherapy preserves hepatic function and maintains metabolic homeostasis in a murine breast cancer model: an experimental preclinical study.Radiation oncology (London, England) · 2026Article
- Fibrosis activityJHEP reports : innovation in hepatology · 2026Article
- Gut-Liver Axis Failure in Critical Alcohol-Associated Liver Disease: From ICU Secondary Hits to Microbiome-Targeted Therapy.Mediators of inflammation · 2026Review
- PD-L1 and the risk of bacterial infection in patients with chronic liver diseases: An international multicohort study.JHEP reports : innovation in hepatology · 2025Article
- Role of procalcitonin in identifying systemic inflammatory response syndrome and sepsis in acute-on-chronic liver failure and its impact on survival.BMC gastroenterology · 2025Article
- Non-invasive tests for MetALD and alcohol-related liver disease.JHEP reports : innovation in hepatology · 2025Review
- [When should a liver disease patient be admitted to the intensive care unit?]Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2024Review
Corrections and comments
- Erratum issued
Authors and funding
19 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background & Aims: Infections are frequent in patients with cirrhosis and worsen prognosis. We evaluated the incidence of infections and their impact on decompensation and death in patients with early alcohol-related liver disease (ALD) during long-term follow-up. Methods: We performed a prospective cohort study of patients in secondary care with a history of excess alcohol intake, no prior decompensation, and with liver biopsies along with clinical investigations conducted at baseline. During follow-up, we reviewed the patients' electronic healthcare records for cases of infections, hospitalizations, transient elastography measurements, decompensations, all-cause mortality, and alcohol intake. Results: We included 461 patients with a mean age of 56±10 years (76% males; fibrosis stage F0-1/F2/F3-4 = 259/107/93 [56%/23%/20%]). During a median follow-up of 4.5 years (IQR 2.9-6.3), 134 patients (29%) developed a total of 312 infections, most frequently pneumonia (106/312, 34%) and urinary tract infections (57/312, 18%). Excessive alcohol intake during follow-up, smoking ≥30 pack years, MELD score and elevated liver stiffness during follow-up were independent predictors of infections. Patients who developed at least one infection had a significantly increased risk of subsequent decompensation (hazard ratio 4.98, 95% CI 2.47-10.03) and death (hazard ratio 8.24, 95% CI 4.65-14.59). Infections increased the risk of decompensation and death independently of baseline fibrosis stage, age, gender, and MELD score. Conclusions: Almost one-third of patients with early ALD develop an infection, which worsens their prognosis by increasing the risk of decompensation and death. The risk of infections increases with liver disease severity and ongoing harmful use of alcohol. Impact and implications: This study reveals that infections significantly worsen the prognosis of patients with early alcohol-related liver disease (ALD), increasing the likelihood of decompensation and death by up to eight times. These findings, pertinent to healthcare providers, researchers, and policymakers, emphasize the importance of early prevention and management of infections in patients with ALD, even those in early stages who may be asymptomatic. It was observed that nearly one-third of patients with early-stage ALD developed infections over 4.5 years, with risk factors including alcohol overuse, smoking, and higher MELD scores. The research underscores the critical need to incorporate these insights into clinical practice and public health policies to improve patient outcomes and mitigate the impact of infections in patients with ALD.
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