New Delhi: There has been a sharp rise in the number of patients visiting AIIMS with alcohol-related liver failure. More alarmingly, the institute says, death rate among these patients is 64% -much higher than mortality from liver failure by hepatitis B virus, a common cause of infection in the organ in the country.
AIIMS admitted 150 patients with alcohol-related liver failure from 2011 to 2015. Of this, the study said, 96 died within 10 days despite all possible medical intervention.
Follow-up of the rest of the patients who were discharged when their condition got stable revealed that nearly 20% died within three to four months and another 20% in a year. “Once you have got acute-onchronic liver failure due to alcohol, survival is rare. Transplant, the only life-saving treatment option, is not possible immediately because three months of abstinence from alcohol is required,“ said Dr Shalimar, associate professor of gastroenterology at AIIMS.
He added that medicines can treat liver infection caused by most hepatitis viruses and even autoimmune hepatitis flare-up can be controlled with medicines, but there is no medicine for alcoholism. “Abstinence is the only way to prevent liver failure and deaths caused by that. The government needs to create awareness to prevent excessive drinking,“ the AIIMS doctor said.
A recent survey published in Global Heart, a reputed medical journal, showed alcohol use has gone up from 16.1% to 25.6% among urban dwellers in Delhi in the past 20 years. The increase in alcohol use in rural areas in the corresponding period is nearly four times -from 8% to 33.2% -the survey found.
Dr Shalimar, who led a research published in Journal of Clinical Gastroenterology, said not only mortality rate, but also incidence of liverdiseases due to alcohol has gone up significantly. “We admitted 427 patients with acute-onchronic liver failure from 2011 to 2015 at the hospital. Of this, a maximum 150 (40.8%) cases were alcohol-related, followed by hepatitis B virus infection (71, 19.3%), hepatitis E (45, 12.2%), autoimmune hepatitis flare-up (17, 4.6%), anti-tuberculosis drugs (16, 4.3%) and hepatitis A (2, 0.5%). In 67 patients (18.2%), the cause of acute liver failure couldn’t be ascertained,“ he said.
The AIIMS doctor added alcohol-related liver failure cases have poorer prognosis.“Most of them required ventilator support, their blood was thinner and brain damage was higher too,“ he added. Dr S K Sarin, director of the Institute of Liver and Biliary Sciences (ILBS), said most alcoholics are calorie-deprived. “Most infections cause leaky bowel. But in case of alcoholics, this problem is severe. Due to this, bacteria easily gets into liver from the small intestine, thus aggravating organ failure status,“ he added.
ILBS is experimenting with several therapies, including stool transplant, plasma exchange and liver dialysis, to increase survival rates in alcohol-related liver failure, Dr Sarin said. He, however, stressed on the need to create awareness about harmful effects of binge drinking. Dr Subhash Gupta, liver transplant surgeon at Max Hospital, Saket, said liver failure due to alcoholism “is a totally preventable disaster“.