Key takeaways:
- Alcohol-related cirrhosis showed twice the mortality risk of MASH-related cirrhosis despite matched severity.
- Portal vein thrombosis was also significantly higher in alcohol-related cirrhosis.
CHICAGO — Alcohol-related cirrhosis carries a twofold higher mortality risk than cirrhosis stemming from metabolic dysfunction-associated steatohepatitis, even when disease severity is matched, noted a presenter at Digestive Disease Week.
Compounding mortality risk, alcohol-related cirrhosis also exhibited significantly higher portal vein thrombosis than MASH-related cirrhosis despite similar rates of liver cancer and no immediate difference in transplant rates after matching for severity.
Alcohol-related cirrhosis carries a twofold higher mortality risk than cirrhosis stemming from metabolic dysfunction-associated steatohepatitis, even when disease severity is matched. Image: Adobe Stock.
Chidera Onwuzo
“Alcohol-related cirrhosis and MASH-related cirrhosis are often discussed within the broad framework of cirrhosis severity, yet their clinical trajectories may not be equivalent even when traditional severity markers appear similar,” Chidera Onwuzo, MD, an internal medicine resident at SUNY Upstate Medical University, told Healio. “We wanted to better understand whether alcohol-related cirrhosis carries a distinct risk profile after accounting for comorbidities and liver severity surrogates.”
Onwuzo and colleagues conducted a retrospective cohort study using data from TriNetX Global Collaborative Network to compare outcomes among adults aged 18 to 65 years with alcohol-related cirrhosis vs. MASH-related cirrhosis, after strict exclusion of other liver diseases and prior transplant.
Researchers established two cohorts — alcohol-related cirrhosis and MASH-related cirrhosis (n = 31,090 each) — using propensity score matching to account for demographics, comorbidities and liver severity markers, with MELD surrogates including bilirubin, international normalized ratio, creatinine, sodium, albumin and platelets.
They used Cox proportional-hazards models with log-rank testing to assess significance of outcomes, including all-cause mortality, portal vein thrombosis, hepatocellular carcinoma and liver transplantation.
“Even after comprehensive matching, alcohol-related cirrhosis was associated with more than a twofold higher mortality risk compared with MASH-related cirrhosis,” Onwuzo said. “We also observed a higher risk of portal vein thrombosis, which suggests that the excess risk may extend beyond what is captured by standard liver severity markers alone.”
Patients with alcohol-related cirrhosis showed significantly worse outcomes compared with MASH-cirrhosis, with more than double the mortality risk (HR = 2.63; 95% CI, 2.53-2.74) and higher portal vein thrombosis (HR = 1.55; 95% CI, 1.4-1.71).
In contrast, the researchers noted that liver transplant rates were not significantly different and HCC incidence was similar between groups.
Onwuzo noted that the “survival gap” between etiologies is likely the result of many factors such as ongoing inflammatory injury, frailty, infection risk, portal hypertension, thrombosis, difficulty sustaining abstinence, and uneven access to longitudinal care and transplant referral. Additionally, he pointed out that standard severity scores may only capture part of the risk and may be missing key behavioral, inflammatory, thrombotic and system-level drivers of alcohol-related cirrhosis.
“Alcohol-related cirrhosis should not be viewed as simply another cirrhosis etiology with the same risk trajectory once MELD-type markers are balanced,” Onwuzo said. “In our analysis, it behaved as a higher-risk phenotype, and that should prompt earlier, more integrated and more proactive care.”
He added: “These findings support earlier risk recognition in alcohol-related cirrhosis, [which] may include closer surveillance for decompensation, more proactive management of portal hypertension and thrombosis risk, early addiction medicine integration, nutritional optimization and timely transplant discussions when appropriate. The data also raise the question of whether referral and eligibility pathways adequately reflect the more accelerated clinical course seen in some patients with alcohol-related cirrhosis.”
For more information:
Chidera Onwuzo, MD, can be reached at gastroenterology@healio.com.
Sources/Disclosures
Source:
Onwuzo C, et al. Alcohol-related cirrhosis faces a deadlier trajectory than MASH despite matched liver severity: A propensity-matched analysis using real-world data. Presented at: Digestive Disease Week; May 2-5, 2026; Chicago.
Disclosures:
Onwuzo reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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