Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Model identified heavy drinkers at highest risk of ALD progression

Key clinical point: A Markov model determined patients’ risk for progression of alcohol-related liver disease.

Major finding: Men and women with steatohepatitis had the highest 5-year risk for liver complications (10.3% and 14.7%, respectively).

Study details: A study of 2,334 heavy drinkers hospitalized in a liver unit.

Disclosures: No funding sources were reported. Ms. Delacôte reported having no conflicts of interest. Three coinvestigators disclosed ties to AbbVie, Bayer Healthcare, Eisai, Gilead, Ipsen, MSD, Novartis, Sanofi, and Servier. The others reported having no conflicts.


Delacôte C et al. Clin Gastroenterol Hepatol. 2020 Jan 11. doi: 10.1016/j.cgh.2019.12.041.


In the life of a hepatologist few things are as gratifying as when a patient with alcohol-related liver disease (ALD) quits drinking. Though we wish this were the norm, ALD is both increasingly common and morbid. Tools to connect with and empower real change in our patients with ALD are urgently needed. Unfortunately, our toolbox is somewhat bare.

To improve, we must become accustomed to (and partner with experts in) the care of substance use disorder. We must learn to maximize the impact of our counseling on our patients. Behavioral interventions for ALD require goal-setting and self-regulation and both depend on the patient’s outcome expectations. All would be immeasurably strengthened with concrete prognostic data.

This is why the Delacôte study is important. The authors create a multistate model with inputs from cohorts of patients with biopsy-proven and staged ALD. The result is a specific 5-year risk of cirrhotic decompensation or hepatocellular carcinoma tailored to the patient’s age, sex, body mass index, alcohol use duration, and liver histology. Although this model’s estimates have confidence intervals and their generalizability would be improved if histology were replaced with noninvasive indices, these data are amongst the most tangible illustrations of risk available for patient-doctor deliberations.

Knowledge, when communicated effectively, is the cornerstone of behavioral change. Translating the abstract concept of progressive ALD into personalized, modifiable risks is a leap forward. We have a new tool, let’s use it.

Elliot B. Tapper, MD, is an assistant professor in gastroenterology and internal medicine at Michigan Medicine, Ann Arbor. He has no conflicts of interest.