Alcohol and Alcoholism Advance Access published online on July 11, 2008
Alcohol and Alcoholism, doi:10.1093/alcalc/agn046
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Influence of Liver Biopsy on Abstinence in Alcohol-Dependent Patients
,1,2,1,4
1 Unités d’Hépatologie, Hôpital Cochin, Paris, France
2 Unité d’Addictologie, Hôpital Cochin, Paris, France
3 INSERM U567, Université René Descartes, Paris, France
* Corresponding author: Unité d’Hépatologie–Hôpital Cochin, 27, rue du Faubourg St Jacques, 75014 Paris, France. Tel.: +33-01-58-41-30-18; E-mail: stanislas.pol{at}cch.aphp.fr
Received 1 February 2008; first review notified 10 March 2008; in revised form 28 March 2008; accepted 3 April 2008
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Abstract |
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Background: Liver biopsy indication for the evaluation of alcoholic liver disease is controversial. Our aim was to investigate the influence of the biopsy on the patients’ motivation for abstinence. Methods: We retrospectively analysed, in a population of 324 patients hospitalized for alcohol withdrawal, the impact of liver biopsy on the following clinical outcomes: rapid loss to follow-up (immediately after hospital discharge), early relapse (< 3 months) and long-lasting abstinence (> 12 months). The biopsy was performed in 136 patients who had liver enzymes perturbations. Hepatic lesions were graded as mild (isolated steatosis and/or non-bridging fibrosis), moderate (bridging fibrosis and/or moderate alcoholic hepatitis) or severe (cirrhosis and/or marked alcoholic hepatitis) in 66 (48%), 41 (30%) and 29 (21%) cases, respectively. Results: In univariate analysis, patients who had a liver biopsy were less likely to be rapidly lost to follow-up (12% versus 27%, P = 0.003) but had a lower rate of long-term abstinence (20% versus 34%, P = 0.025). In multivariate analysis, age was the only factor significantly associated with clinical outcome: older patients had higher rate of long-term abstinence (OR = 1.041; P = 0.010). Among patients who had a biopsy, those with severe hepatic lesions had a lower rate of rapid relapse than those with moderate or mild lesions (32% versus 68% and 56%, P = 0.018) but the rate of long-term abstinence was similar in the three groups. Conclusion: This observational study does not support the notion that liver biopsy has a significant influence on the maintenance of alcohol abstinence in patients with alcoholic liver disease.
Both authors contributed equally to this work. 4 Present address: Pôle Addictologie Prévention Education, Centre Hospitalier Victor Jousselin, Dreux, France.