Risk Stratification

One unit of alcohol is equivalent to 8 g of ethanol (half pint of beer at 3.5% or 25 ml of spirits). Hazardous drinking is defined as regular daily consumption of over 5 units of alcohol for men (>40 g) and over 3 units for women (>24 g). Harmful drinking causes damage to physical or mental health.

Alcohol dependence is behaviour centred on the need to drink alcohol. [9] Evidence suggests drinking 60-80 g per day of alcohol for men and >20 g per day for women increases the risk of ArLD. Although studies have shown that a low number of patients (13.5%) with alcohol intake >120 g per day developed ArLD.

Risk factors

Clearly there are risk factors which increase the likelihood of ArLD happening, such as:

• Age
• Gender
• Genetics

Alcohol-related cirrhosis occurs in only 8-20% of alcoholic patients and Alcohol-related hepatitis in 6-30%.

The prognosis (long-term) improves with abstinence; the five year survival rate for those with compensated cirrhosis who continue to abuse alcohol is less than 70% with survival of >90% if they stop drinking. Decompensated liver disease survival drops to 30% in five years for those still drinking alcohol. [6]

Learning Bite

Prognosis in all stages of ArLD improves with abstinence from alcohol.

In suspected severe alcohol-related hepatitis, clinicians should be aware that specialist teams use prognostic tools such as Maddrey Discriminant Function, Glasgow Alcoholic Hepatitis Score, and increasingly MELD, to support decisions about corticosteroids and escalation. [10]