Three critical months for patients with decompensated alcohol-related cirrhosis

Objective Liver transplant guidelines in the UK mandate a minimum of 3 months of abstinence for patients with alcohol-related liver disease. We assessed the outcomes of patients in our region during an admission to hospital with decompensated alcohol-related cirrhosis and in the subsequent, critical, 3 months. Design A network of clinicians and nurse specialists in East Anglia collected prospective data on admissions for this regional service evaluation. We included patients aged 18–70 years admitted with decompensated alcohol-related cirrhosis. Data were collected between 1 February 2023 and 30h April 2023, and outcomes analysed at 3 months post admission. Results Data were provided for 203 patients from 10 centres. Patients were 59% male with a median UK Model for End-stage Liver Disease (UKELD) score of 57 (range 43–67), 93% having a UKELD≥49 and 47% having Child Pugh C disease. On admission, 72% of patients were consuming alcohol. Of those, 48% were reviewed by an Alcohol Care Team during their admission and 47% were engaged with alcohol services at 3 months. The relapse rate to alcohol at 3 months was 65%. At 3 months, 10% of the total cohort were transplanted or referred for transplant assessment. Mortality at 3 months was 24%. 47% of the surviving cohort were ineligible for transplant consideration due to ongoing alcohol use. 8% of the cohort had been lost to follow-up. Conclusions In the critical 3 months following an admission to hospital with decompensated cirrhosis, patients experienced high levels of mortality, relapse to alcohol and drop out from follow-up.