Gastroenterology and Hepatology Department, Hospital de Santa Maria, CHULN, Lisbon, Portugal.
Nephrology Department, Hospital de Curry Cabral, CHULC, Lisbon, Portugal.
PLoS One. 2021 May 25;16(5):e0252218. doi: 10.1371/journal.pone.0252218. eCollection 2021.
Most long-term heavy drinkers do not have clinically evident chronic liver disease (CLD). However, at any time-point, their risk of developing CLD remains unknown. We aimed to evaluate the long-term outcomes of a group of heavy drinkers, without evidence of CLD at baseline.
A cohort of 123 long-term heavy drinkers without CLD were prospectively recruited in 2002 and retrospectively followed until 2018.
At baseline (2002), median alcohol consumption was 271±203g/day during 21.5±20 years, 65% being abstinent during the previous 1.75±5 months. Patients were followed for 14±3 years. During follow-up, 53% reported any alcohol intake. Alcohol consumption during follow-up associated weakly with either 1- or 6-months previous abstinence at baseline. Until 2018, progression to CLD occurred in 6%, associating with years of alcohol intake during follow-up (OR 1.15 [1.01-1.31]) and baseline alkaline-phosphatase (OR 1.05 [1.01-1.10]). During follow-up, being abstinent for at least 1 year positively associated with CLD-free survival. 27% died (55% of cancer-mostly oropharyngeal cancer, 27% of cardiovascular disease, and 9% of liver disease), with a mean age of 71 years [69-74] (10 years less than the expected in the Portuguese population). Achieving abstinence for at least 1 year positively associated with overall survival, while smoking, and hepatic steatosis at baseline associated negatively.
Long-term heavy drinkers seemed to have a decreased life expectancy compared with the overall Portuguese population. Cancer was the main cause of death. Our results suggest that progression to CLD depends mostly on continued alcohol intake. Alcohol abstinence, even if temporary, seems to decrease the risks of CLD and mortality.
大多数长期重度饮酒者没有明显的慢性肝病（CLD）。然而，在任何时间点，他们发展为 CLD 的风险仍不清楚。我们旨在评估一组在基线时无 CLD 证据的长期重度饮酒者的长期结局。
2002 年前瞻性招募了一组 123 名无 CLD 的长期重度饮酒者，并进行了回顾性随访，直至 2018 年。
在基线（2002 年）时，中位数酒精摄入量为 271±203g/天，持续 21.5±20 年，65%的人在过去 1.75±5 个月内戒酒。患者随访 14±3 年。随访期间，53%的人报告有任何饮酒。随访期间的酒精摄入量与基线时 1 个月或 6 个月的戒酒情况呈弱相关。直到 2018 年，6%的患者进展为 CLD，与随访期间的饮酒年数相关（OR 1.15 [1.01-1.31]）和基线碱性磷酸酶相关（OR 1.05 [1.01-1.10]）。随访期间，至少戒酒 1 年与无 CLD 生存显著相关。27%的患者死亡（55%死于癌症，主要是口咽癌，27%死于心血管疾病，9%死于肝脏疾病），平均年龄为 71 岁[69-74]（比葡萄牙人口预期寿命少 10 岁）。至少戒酒 1 年与总生存显著相关，而基线时的吸烟和肝脂肪变性与总生存负相关。
与葡萄牙总人口相比，长期重度饮酒者的预期寿命似乎缩短。癌症是主要的死亡原因。我们的研究结果表明，CLD 的进展主要取决于持续的饮酒。即使是暂时的戒酒，似乎也能降低 CLD 和死亡率的风险。
