PROFILE OF ALCOHOL-RELATED LIVER DISEASE AMONG PATIENTS ATTENDING TERTIARY CARE HOSPITAL IN INDIA.(INSIGHTS FROM STUDY IN NORTHWESTERN INDIA
Main Article Content
Keywords
Alcohol-related liver disease, Drinking pattern, MELD score, Child-Pugh score, Neutrophil-lymphocyte ratio, Hepatic encephalopathy, HRS.
Abstract
Alcohol related liver disease (ALD) is one of the most common cause for chronic liver disease and deaths in India. Material and methods This was a prospective observational study at the tertiary care centre to determine the clinical profile, pattern of drink, biochemistry of liver function test as well as prognostic factors in patients with ALD. We included a total of 281 patients with heavy drinking and liver disorder. Majority of the patients were males (90.75%), from lower middle and lower socio-economic status, Most of them being rurality, consuming country made liquor for more than 10–20 years on a daily basis. The most frequent complications were ascites, gastrointestinal bleeding, hepatic encephalopathy and hepatorenal syndrome.Laboratory test results included anaemia, hyperbilirubinemia, AST/ALT> 1:5, hypoalbuminemia and extended INR. Frequency of consumption of country liquor and >20 years alcohol consuming patients had significantly higher disease severity scores (Maddrey DF, MELD, and Child-Pugh). Neutrophil/lymphocyte ratio was significantly correlated with the prognostic scores, and may be a useful simple prognostic factor. General mortality was 18.15% and its occurrence increased, reaching maximum prevalences in hepatorenal syndrome and hepatic encephalopathy complexes.
References
1. Pal HR, Jena R, Yadav D. Validation of the alcohol use disorders identification test (AUDIT) in urban community outreach and de-addiction centre samples in north India. J Stud Alcohol. 2004;65:794–800.
2. Sample Registration System Baseline Survey 2014. [Last cited on 2017 Aug 10].
3. World Health Organization (WHO). India. Alcohol Consumption levels and patterns. [Last cited on 2017 Jul 29]
4. World Health Organization. Global Health Observatory data repository. [Last cited on 2017 Aug 15].
5. Nayak MB, Bond JC, Cherpitel C. Detecting alcohol-related problems in developing countries: a comparison of 2 screening measures in India. Alcohol Clin Exp Res. 2009;33:2057–66.
6. Rajeev A, Abraham SB, Reddy TG, Skariah CM, Indiradevi ER, Abraham J. A community study of alcohol consumption in a rural area of South India. Int J Community Med Public Health. 2017;4:2172–7.
7. Levy RE, Catana AM, Durbin-Johnson B, et al. Ethnic differences in presentation and severity of the alcohol-related liver disease. Alcoholism: Clinical and Experimental Research. 2015;39(3):566–574.
8. Abdel-Misih SR, Bloomston M. Liver anatomy. Surg Clin North Am. 2010;90(4):643-653.
9. Sibulesky L. Normal liver anatomy. Clin Liver Dis (Hoboken). 2013;2(Suppl 1): S1-S3. Published 2013 Mar 29.
10. Zhao R, Duncan SA. Embryonic development of the liver. Hepatology. 2005 May;41(5):956-67.
11. Gerber MA, Thung SN. Histology of the liver. Am J Surg Pathol. 1987 Sep;11(9):709-22.
12. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Alcohol Drinking. Lyon (FR): International Agency for Research on Cancer; 1988. (IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, No. 44.) 3, Chemical Composition of Alcoholic Beverages, Additives and Contaminants.
13. Lucey MR. Liver transplantation for alcohol-related liver disease. Nature Reviews. Gastroenterology &Hepatology. 2014;11(5):300–307.
14. Masson S, Emmerson I, Henderson E, et al. Clinical but not histological factors predict long-term prognosis in patients with histologically advanced non-decompensated alcohol-related liver disease. Liver International. 2014;34(2):235–242.
15. Meier P, Seitz HK. Age, alcohol metabolism and liver disease. Current Opinion in Clinical Nutrition and Metabolic Care. 2008;11(1):21–26.
16. Mohammad MK, Zhou Z, Cave M, et al. Zinc and liver disease. Nutrition in Clinical Practice. 2012;27(1):8–20.
17. Zakhari S. Bermuda Triangle for the liver: Alcohol, obesity, and viral hepatitis. Journal of Gastroenterology and Hepatology. 2013;28(Suppl 1):18–25.
18. Kakunje A, Kanaradi H, Pai G, Karkal R, Nafisa D, Chandrasekaran P. Drinking pattern in persons with alcohol dependence with and without cirrhosis: A hospital-based comparative study. Indian J Psychiatry. 2018;60(2):189-194.
19. Smith S, White J, Nelson C, Davies M, Lavers J, Sheron N, et al. Severe alcohol-induced liver disease and the alcohol dependence syndrome. Alcohol Alcohol. 2006;41:274–7.
20. Stickel F, Hampe J. Genetic determinants of alcohol-related liver disease. Gut. 2012;61(1):150–159.
21. Suraweera DB, Weeratunga AN, Hu RW, et al. Alcoholic hepatitis: The pivotal role of Kupffer cells. World Journal of Gastrointestinal Pathophysiology. 2015;6(4):90–98.
22. Patrick ME, Cronce JM, Fairlie AM, Atkins DC, Lee CM. Day-to-day variations in high-intensity drinking, expectancies, and positive and negative alcohol-related consequences. Addict Behav. 2016 Jul; 58():110-6.
23. Kamran U, Towey J, Khanna A, Chauhan A, Rajoriya N, Holt A. Nutrition in alcohol-related liver disease: Physiopathology and management. World J Gastroenterol. 2020;26(22):2916-2930.
24. Szabo G, Aloman C, Polyak SJ, et al. Hepatitis C infection and alcohol use: A dangerous mix for the liver and antiviral immunity. Alcoholism: Clinical and Experimental Research. 2006; 30(4):709–719.
25. Thomes PG, Osna NA, Davis JS, Donohue TM., Jr Cellular steatosis in ethanol oxidizing-HepG2 cells is partially controlled by the transcription factor, early growth response-1. International Journal of Biochemistry & Cell Biology. 2013;45(2):454–463.
26. Nagy LE, Ding WX, Cresci G, et al. Linking pathogenic mechanisms of alcohol-related liver disease with clinical phenotypes. Gastroenterology. 2016;150(8):1756–1768.
27. Osna NA, White RL, Krutik VM, et al. Proteasome activation by hepatitis C core protein is reversed by ethanol-induced oxidative stress. Gastroenterology. 2008;134(7):2144–2152.
28. Pavlov CS, Casazza G, Semenistaia M, et al. Ultrasonography for diagnosis of alcoholic cirrhosis in people with alcohol-related liver disease. Cochrane Database of Systematic Reviews. 2016; 3:CD011602.
29. Rathod SD, Nadkarni A, Bhana A, Shidhaye R. Epidemiological features of alcohol use in rural India: a population-based cross-sectional study. Br Med J. 2015;5:1–8. 22. Howard D, Nancy RC, Julie EB, Joann E, Manson, Michael G. Alcohol consumption and the risk of hypertension in women and men. Hypertension. 2008;51:1080–87.
30. Kanwar P, Sharma RC, Sharma DD, Kanwar N. A study of psychiatric co-morbidity among alcohol dependents. Int J Res Med Sci. 2017;5:4490–6.
31. Addolorato G, Mirijello A, Barrio P, Gual A. Treatment of alcohol use disorders in patients with alcohol-related liver disease. Journal of Hepatology. 2016;65(3):618–630.
32. Singal AK, Bashar H, Anand BS, et al. Outcomes after liver transplantation for alcoholic hepatitis are similar to alcoholic cirrhosis: Exploratory analysis from the UNOS database. Hepatology . 2012;55(5):1398–1405.
33. Ambade A, Mandrekar P. Oxidative stress and inflammation: Essential partners in alcohol-related liver disease. International Journal of Hepatology. 2012;2012;853175
34. Anstee QM, Seth D, Day CP. Genetic factors that affect risk of alcoholic and nonalcoholic fatty liver disease. Gastroenterology. 2016;150(8):1728–1744.e7.
35. Burza MA, Molinaro A, Attilia ML, et al. PNPLA3 I148M (rs738409) genetic variant and age at onset of at-risk alcohol consumption are independent risk factors for alcoholic cirrhosis. Liver International. 2014;34(4):514–520.
36. Shearn CT, Fritz KS, Shearn AH, et al. Deletion of GSTA4-4 results in increased mitochondrial post-translational modification of proteins by reactive aldehydes following chronic ethanol consumption in mice. Redox Biology. 2016;7:68–77.
37. Donnadieu-Rigole H, Olive L, Nalpas B, et al. Follow-up of alcohol consumption after liver transplantation: Interest of an addiction team? Alcoholism: Clinical and Experimental Research. 2017;41(1):165–170.
38. Singal AK, Chaha KS, Rasheed K, Anand BS. Liver transplantation in alcohol-related liver disease current status and controversies. World Journal of Gastroenterology. 2013;19(36):5953–5963.
39. Siu L, Foont J, Wands JR. Hepatitis C virus and alcohol. Seminars in Liver Disease. 2009 ;29(2):188–199.
40. Dong X, Liu H, Chen F, et al. MiR-214 promotes the alcohol-induced oxidative stress via down-regulation of glutathione reductase and cytochrome P450 in liver cells. Alcoholism: Clinical and Experimental Research. 2014;38(1):68–77.
41. Patek, Donohue TM., Jr Alcohol-induced steatosis in liver cells. World Journal of Gastroenterology. 2007;13(37):4974–4978.
42. European Association for the Study of the Liver. EASL clinical practical guidelines: Management of alcohol-related liver disease. Journal of Hepatology. 2012;57(2):399–420.
43. Frazier TH, Stocker AM, Kershner NA, et al. Treatment of alcohol-related liver disease. Therapeutic Advances in Gastroenterology. 2011;4(1):63–81
44. Fujita T, Soontrapa K, Ito Y, et al. Hepatic stellate cells relay inflammation signalling from sinusoids to parenchyma in mouse models of immune-mediated hepatitis. Hepatology . 2016;63(4):1325–1339.
45. Ganesan M, Natarajan SK, Zhang J, et al. Role of apoptotic hepatocytes in HCV dissemination: Regulation by acetaldehyde. American Journal of Physiology: Gastrointestinal and Liver Physiology. 2016;310(11): G930–G940.
46. Ganesan M, Zhang J, Bronich T, et al. Acetaldehyde accelerates HCV-induced impairment of innate immunity by suppressing methylation reactions in liver cells. American Journal of Physiology: Gastrointestinal and Liver Physiology. 2015;309(7): G566–G577.
47. Gitto S, Vitale G, Villa E, Andreone P. Update on alcohol and viral hepatitis. Journal of Clinical and Translational Hepatology. 2014;2(4):228–233.
48. Kang L, Chen X, Sebastian BM, et al. Chronic ethanol and triglyceride turnover in white adipose tissue in rats: Inhibition of the anti-lipolytic action of insulin after chronic ethanol contributes to increased triglyceride degradation. Journal of Biological Chemistry. 2007;282(39):28465–28473.
49. Zakhari S, Li TK. Determinants of alcohol use and abuse: Impact of quantity and frequency patterns on liver disease. Hepatology. 2007;46(6):2032–2039.
50. Kharbanda KK, Todero SL, Ward BW, et al. Betaine administration corrects ethanol-induced defective VLDL secretion. Molecular and Cellular Biochemistry. 2009;327(1–2):75–78.
51. Kirpich IA, Miller ME, Cave MC, et al. Alcohol-related liver disease: Update on the role of dietary fat. Biomolecules. 2016;6(1):1
52. Pati S, Swain S, Mahapatra S, Hussain MA, Pati S. Prevalence, pattern, and correlates of alcohol misuse among male patients attending rural primary care in India. J Pharm BioallSci 2017;9:66-72
53. Wang ZG, Dou XB, Zhou ZX, Song ZY. Adipose tissue-liver axis in alcohol-related liver disease. World Journal of Gastrointestinal Pathophysiology. 2016;7(1):17–26
54. Kim MS, Ong M, Qu X. Optimal management for alcohol-related liver disease: Conventional medications, natural therapy or combination? World Journal of Gastroenterology. 2016;22(1):8–23.
55. Seronello S, Montanez J, Presleigh K, et al. Ethanol and reactive species increase basal sequence heterogeneity of hepatitis C virus and produce variants with reduced susceptibility to antivirals. PLoS One. 2011;6(11):e27436.
56. Sofair AN, Barry V, Manos MM, et al. The epidemiology and clinical characteristics of patients with newly diagnosed alcohol-related liver disease: Results from population-based surveillance. Journal of Clinical Gastroenterology. 2010;44(4):301–307.
57. Girish N, Kavita R, Gururaj G, Benegal V. Alcohol use and implications for public health: Patterns of use in four communities. Indian J Community Med. 2010;35:238.
58. Ghosh S, Samanta A, Mukherjee S. Patterns of alcohol consumption among male adults at a slum in Kolkata, India. J Health Popul Nutr. 2012;30:73.
59. Kumar SG, Premarajan KC, Subitha L, Suguna E, Vinayagamoorthy, Kumar V. Prevalence and pattern of alcohol consumption using alcohol use disorders identification test (AUDIT) in rural Tamil Nadu. J ClinDiagn Res. 2013;7:1637–9.
60. Lakshmi A, Daisy D, Duttagupta, Lendi J, Padmanaban Drinking Habits, Health, Social and Behavioural Aspects of Alcohol Users in A Semi-Urban Population In Chennai. IOSR-JDMS. 2014;13:20–22.
61. Dewan G, Chowdhury FR. Alcohol use and alcohol use disorders in Bangladesh. Asia Pac J Med Toxicol. 2015;4:83–90.
62. Vidhukumar K, Nazeer E, Anil P. Prevalence and pattern of alcohol use in Kerala – A district-based survey. IJRSTAT. 2016;18:363–7.
63. Ramanan VV, Singh SK. A study on alcohol use and its related health and social problems in rural Puducherry, India. J Family Med Prim Care. 2016;5:804.
64. Manimunda SP, Sugunan AP, Thennarasu K, Pandian D, Pesala KS, Benegal V. Alcohol consumption, hazardous drinking, and alcohol dependency among the population of Andaman and Nicobar Islands, India. Indian J Public Health. 2017;61:105.
65. Bute J, Kori S, Arora VK, Sahasrabuddhe A. Prevalence and pattern of alcohol consumption among males attending primary health care setting using AUDIT in rural Indore, Madhya Pradesh, India. Int J Community Med Public Health. 2018;5:4461–9.
66. Eashwar VM, Gopalakrishnan S, Umadevi R, Geetha A. Epidemiology of alcohol consumption in an urban area of Kancheepuram district, Tamil Nadu. J Family Med Prim Care. 2019;8:1098–105.
67. Teli SA, Joshi Y. Prevalence of alcohol consumption in an urban population of Dehradun. Asian J Pharm Res. 2019;9:87–9.
68. Wangdi K, Jamtsho T. Prevalence and correlates of current alcohol use among Bhutanese adults: A nationally representative survey data analysis. Indian J Psychol Med. 2019;41:38
69. Gururaj G, Isaac MK. Psychiatric Epidemiology in India: Moving Beyond Numbers An Indian Perspective. New Delhi: Elsevier Publications; 1993. p. 37.
70. Bonu S, Rani M, Peters DH, Jha P, Nguyem SN. Does use of tobacco or alcohol contribute to impoverishment from hospitalisation costs in India? Health Policy Plan. 2005;20:41–9.
71. Benegal V, Velayudan A, Jain S. The social costs of alcoholism (Karnataka) NIMHANS J. 2000;18:67–76.
72. Wei X, Shi X, Zhong W, et al. Chronic alcohol exposure disturbs lipid homeostasis at the adipose tissue-liver axis in mice: Analysis of triacylglycerols using high-resolution mass spectrometry in combination with in vivo metabolite deuterium labeling. PLoS One. 2013;8(2):e55382.
73. Thursz M, Forrest E, Roderick P, et al. The clinical effectiveness and cost-effectiveness of Steroids Or Pentoxifylline for Alcoholic Hepatitis (STOPAH): A 2 × 2 factorial rando mised controlled trial. Health Technology Assessment. 2015;19(102):1–104.
74. Pathak OK, Paudel R, Panta OB, Pant HP, Giri BR, Adhikari B. Retrospective study of the clinical profile and prognostic indicators in patients of alcohol-related liver disease admitted to a tertiary care teaching hospital in Western Nepal. Saudi J Gastroenterol. 2009;15(3):171-175.
75. Nagamani R, Sakuntala. Clinical profile of alcohol-related liver disease patients in a tertiary care teaching hospital and its correlation with type of alcoholic beverage consumption. International Journal of Medical and Health Research Volume 2; Issue 6; June 2016; Page No. 12-14
76. Sarin SK, Malhotra V, Nayyar A, Sundaram KR, Broor SL. Profile of alcohol-related liver disease in an Indian hospital. A prospective analysis. Liver. 1988;8(3):132-137.
77. Khatroch, Shamsunder. Study of clinical and biochemical profile of acute alcohol-related liver disease in a teaching hospital in Telangana. International Journal of Advances in Medicine, [S.l.], v. 5, n. 4, p. 804-808, July 2018.
78. Phuntshochoden, Yadvendra singh Sirohi, Praveen kumarsharma, V k sashindaran, a study of clinical profile of alcohol-related liver disease and its relation to alcohol dependence syndrome, Indian journal of applied research: volume-8 | issue-6 | June-2018
79. Rishi, Jain AK, Nandy P. Study of clinical, laboratory, and upper gastrointestinal endoscopic profile in patients of alcohol-related liver disease in Sikkim. Med J DY Patil Vidyapeeth 2018;11:228-31
80. Sheshrao S Chavan, Siddheshvar V Birajdar, Nikhil R Pawar. Clinical profile of patients with alcohol use disorder. IAIM, 2018; 5(2): 48-56.
81. Ravindra K Hadakshi, DGaurav Modi. International Journal of Medical Science and Education Int. j.med. sci.Educ. July-September 2018; 5(3):364-368
82. Jeewan Kumar Mitra, PraneetAnsalMundu, Bindey Kumar, Rajendra Kumar Satapathy, Rashmi Sinha, Manish Kumar. Profile of alcohol-related liver disease in the population of Jharkhand: an insight into the realm of alcoholism from profligacy to burden. International Journal of Contemporary Medical Research 2017;4(3):770- 773.
83. Jawgam Umbon, Kalpana Niranjan. A study of clinical profile and prognostic indicators of alcohol-related liver disease in a tertiary care centre of northeast India. Journal of evidence-based medicine.4175-4180
84. NityaNand, Parveen Malhotra, Dipesh Kumar Dhoot. Clinical Profile of Alcohol-related liver disease in a Tertiary Care Centre and its Correlation with Type, Amount and Duration of Alcohol Consumption. June 2015 (63).
85. Swati Hegde, ArunVishnar, Girish B. Ramteke. Study of clinical and laboratory profile in alcohol-related liver disease with emphasis on renal function. Int Jour of research in med sci. 2015;2 (3)
86. Cabez J, bataller R. Alcohol-related liver disease: New UK alcohol guidelines and Dry January: enough to give up boozing? Nat Rev Gatroentrol Hepato 2016; 13:191.0
87. Torruellas C, French SW, Medici V. Diagnosis of alcohol-related liver disease. World J Gastroenterol. 2014;20(33):11684-11699.
88. Ray G, Manjubhargav P. Clinical Presentation and Mortality Determinants of Alcohol-Related Liver Disease: A Single-Center Experience of the Rising Menace from Eastern India. InflammIntest Dis. 2019;4(3):104-114.
89. Huang LL, Xia HH, Zhu SL. Ascitic Fluid Analysis in the Differential Diagnosis of Ascites: Focus on Cirrhotic Ascites. J ClinTranslHepatol. 2014;2(1):58-64.
90. O'Shea RS, Dasarathy S, McCullough AJ (January 2010). "Alcohol-related liver disease: AASLD Practice Guidelines" (PDF). Hepatology. 51 (1): 307–28.
91. Bruha R, Dvorak K, Petrtyl J. Alcohol-related liver disease. World J Hepatol. 2012;4(3):81-90.
92. Hasin DS, O'Brien CP, Auriacombe M, et al. DSM-5 criteria for substance use disorders: recommendations and rationale. Am J Psychiatry. 2013;170(8):834-851.
93. Schuppan D, Afdhal NH. Liver cirrhosis. Lancet. 2008;371(9615):838-851.
94. Gül F, Arslantaş MK, Cinel İ, Kumar A. Changing Definitions of Sepsis. Turk J AnaesthesiolReanim. 2017;45(3):129-138.
95. Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases. J Hepatol. 2014; 61: 642-659
96. Ng CK, Chan MH, Tai MH, Lam CW. Hepatorenal syndrome. ClinBiochem Rev. 2007;28(1):11-17.
97. Roth JA, Chrobak C, Schädelin S, Hug BL. MELD score as a predictor of mortality, length of hospital stay, and disease burden: A single-centre retrospective study in 39,323 inpatients. Medicine (Baltimore). 2017;96(24):e7155.
98. Kamath PS, Kim WR; Advanced Liver Disease Study Group. The model for end-stage liver disease (MELD). Hepatology. 2007 Mar;45(3):797-805.
99. Peng Y, Qi X, Guo X. Child-Pugh Versus MELD Score for the Assessment of Prognosis in Liver Cirrhosis: A Systematic Review and Meta-Analysis of Observational Studies. Medicine (Baltimore). 2016;95(8):e2877
100. Vignesh BT, Singh AK, Mohan SK, Murthy S, Joshi A. Association between socio-demographics and alcohol dependence among individuals living in an Indian setting. Glob J Health Sci. 2014;6(3):16-26.
101. MP Virukal pattigopalratnam, Anil Arora,S. Mukhewar .Socio economic and demographic profile of patients with alcohol-related liver disease in India. Journal of clinical and experimental hepatolog.2013;22-28
102. Narawane NM, Bhatia S, Abraham P, Sanghani S, Sawant SS. Consumption of 'country liquor' and its relation to alcohol-related liver disease in Mumbai. J Assoc Physicians India. 1998 Jun;46(6):510-3.
103. Askgaard G, Grønbæk M, Kjær MS, Tjønneland A, Tolstrup JS. Alcohol drinking pattern and risk of alcoholic liver cirrhosis: a prospective cohort study. J Hepatol. 2015 May;62(5):1061-7.
104. Bellentani S, Saccoccio G, Costa G, Tiribelli C, Manenti F, Sodde M, SaveriaCrocè L, Sasso F, Pozzato G, Cristianini G, Brandi G. Drinking habits as cofactors of risk for alcohol-induced liver damage. The Dionysos Study Group. Gut. 1997 Dec;41(6):845-50.
105. Kerr WC, Fillmore KM, Marvy P. Beverage-specific alcohol consumption and cirrhosis mortality in a group of English-speaking beer-drinking countries. Addiction. 2000 Mar;95(3):339-46.
106. Becker U, Deis A, Sørensen TI, Grønbaek M, Borch-Johnsen K, Müller CF, Schnohr P, Jensen G. Prediction of risk of liver disease by alcohol intake, sex, and age: a prospective population study. Hepatology. 1996 May;23(5):1025-9.
107. Savolainen. Oscar-Berman M, Marinkovic K. Alcohol: effects on neurobehavioral functions and the brain. Neuropsychol Rev. 2007;17(3):239-257.
108. Anand Roy N. Prevalence and determinants of co-use of alcohol and tobacco among men in the working-age group (18-59 years) in India. EpidemiolBiostat Public Health. 2016;13:804–08.
2. Sample Registration System Baseline Survey 2014. [Last cited on 2017 Aug 10].
3. World Health Organization (WHO). India. Alcohol Consumption levels and patterns. [Last cited on 2017 Jul 29]
4. World Health Organization. Global Health Observatory data repository. [Last cited on 2017 Aug 15].
5. Nayak MB, Bond JC, Cherpitel C. Detecting alcohol-related problems in developing countries: a comparison of 2 screening measures in India. Alcohol Clin Exp Res. 2009;33:2057–66.
6. Rajeev A, Abraham SB, Reddy TG, Skariah CM, Indiradevi ER, Abraham J. A community study of alcohol consumption in a rural area of South India. Int J Community Med Public Health. 2017;4:2172–7.
7. Levy RE, Catana AM, Durbin-Johnson B, et al. Ethnic differences in presentation and severity of the alcohol-related liver disease. Alcoholism: Clinical and Experimental Research. 2015;39(3):566–574.
8. Abdel-Misih SR, Bloomston M. Liver anatomy. Surg Clin North Am. 2010;90(4):643-653.
9. Sibulesky L. Normal liver anatomy. Clin Liver Dis (Hoboken). 2013;2(Suppl 1): S1-S3. Published 2013 Mar 29.
10. Zhao R, Duncan SA. Embryonic development of the liver. Hepatology. 2005 May;41(5):956-67.
11. Gerber MA, Thung SN. Histology of the liver. Am J Surg Pathol. 1987 Sep;11(9):709-22.
12. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Alcohol Drinking. Lyon (FR): International Agency for Research on Cancer; 1988. (IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, No. 44.) 3, Chemical Composition of Alcoholic Beverages, Additives and Contaminants.
13. Lucey MR. Liver transplantation for alcohol-related liver disease. Nature Reviews. Gastroenterology &Hepatology. 2014;11(5):300–307.
14. Masson S, Emmerson I, Henderson E, et al. Clinical but not histological factors predict long-term prognosis in patients with histologically advanced non-decompensated alcohol-related liver disease. Liver International. 2014;34(2):235–242.
15. Meier P, Seitz HK. Age, alcohol metabolism and liver disease. Current Opinion in Clinical Nutrition and Metabolic Care. 2008;11(1):21–26.
16. Mohammad MK, Zhou Z, Cave M, et al. Zinc and liver disease. Nutrition in Clinical Practice. 2012;27(1):8–20.
17. Zakhari S. Bermuda Triangle for the liver: Alcohol, obesity, and viral hepatitis. Journal of Gastroenterology and Hepatology. 2013;28(Suppl 1):18–25.
18. Kakunje A, Kanaradi H, Pai G, Karkal R, Nafisa D, Chandrasekaran P. Drinking pattern in persons with alcohol dependence with and without cirrhosis: A hospital-based comparative study. Indian J Psychiatry. 2018;60(2):189-194.
19. Smith S, White J, Nelson C, Davies M, Lavers J, Sheron N, et al. Severe alcohol-induced liver disease and the alcohol dependence syndrome. Alcohol Alcohol. 2006;41:274–7.
20. Stickel F, Hampe J. Genetic determinants of alcohol-related liver disease. Gut. 2012;61(1):150–159.
21. Suraweera DB, Weeratunga AN, Hu RW, et al. Alcoholic hepatitis: The pivotal role of Kupffer cells. World Journal of Gastrointestinal Pathophysiology. 2015;6(4):90–98.
22. Patrick ME, Cronce JM, Fairlie AM, Atkins DC, Lee CM. Day-to-day variations in high-intensity drinking, expectancies, and positive and negative alcohol-related consequences. Addict Behav. 2016 Jul; 58():110-6.
23. Kamran U, Towey J, Khanna A, Chauhan A, Rajoriya N, Holt A. Nutrition in alcohol-related liver disease: Physiopathology and management. World J Gastroenterol. 2020;26(22):2916-2930.
24. Szabo G, Aloman C, Polyak SJ, et al. Hepatitis C infection and alcohol use: A dangerous mix for the liver and antiviral immunity. Alcoholism: Clinical and Experimental Research. 2006; 30(4):709–719.
25. Thomes PG, Osna NA, Davis JS, Donohue TM., Jr Cellular steatosis in ethanol oxidizing-HepG2 cells is partially controlled by the transcription factor, early growth response-1. International Journal of Biochemistry & Cell Biology. 2013;45(2):454–463.
26. Nagy LE, Ding WX, Cresci G, et al. Linking pathogenic mechanisms of alcohol-related liver disease with clinical phenotypes. Gastroenterology. 2016;150(8):1756–1768.
27. Osna NA, White RL, Krutik VM, et al. Proteasome activation by hepatitis C core protein is reversed by ethanol-induced oxidative stress. Gastroenterology. 2008;134(7):2144–2152.
28. Pavlov CS, Casazza G, Semenistaia M, et al. Ultrasonography for diagnosis of alcoholic cirrhosis in people with alcohol-related liver disease. Cochrane Database of Systematic Reviews. 2016; 3:CD011602.
29. Rathod SD, Nadkarni A, Bhana A, Shidhaye R. Epidemiological features of alcohol use in rural India: a population-based cross-sectional study. Br Med J. 2015;5:1–8. 22. Howard D, Nancy RC, Julie EB, Joann E, Manson, Michael G. Alcohol consumption and the risk of hypertension in women and men. Hypertension. 2008;51:1080–87.
30. Kanwar P, Sharma RC, Sharma DD, Kanwar N. A study of psychiatric co-morbidity among alcohol dependents. Int J Res Med Sci. 2017;5:4490–6.
31. Addolorato G, Mirijello A, Barrio P, Gual A. Treatment of alcohol use disorders in patients with alcohol-related liver disease. Journal of Hepatology. 2016;65(3):618–630.
32. Singal AK, Bashar H, Anand BS, et al. Outcomes after liver transplantation for alcoholic hepatitis are similar to alcoholic cirrhosis: Exploratory analysis from the UNOS database. Hepatology . 2012;55(5):1398–1405.
33. Ambade A, Mandrekar P. Oxidative stress and inflammation: Essential partners in alcohol-related liver disease. International Journal of Hepatology. 2012;2012;853175
34. Anstee QM, Seth D, Day CP. Genetic factors that affect risk of alcoholic and nonalcoholic fatty liver disease. Gastroenterology. 2016;150(8):1728–1744.e7.
35. Burza MA, Molinaro A, Attilia ML, et al. PNPLA3 I148M (rs738409) genetic variant and age at onset of at-risk alcohol consumption are independent risk factors for alcoholic cirrhosis. Liver International. 2014;34(4):514–520.
36. Shearn CT, Fritz KS, Shearn AH, et al. Deletion of GSTA4-4 results in increased mitochondrial post-translational modification of proteins by reactive aldehydes following chronic ethanol consumption in mice. Redox Biology. 2016;7:68–77.
37. Donnadieu-Rigole H, Olive L, Nalpas B, et al. Follow-up of alcohol consumption after liver transplantation: Interest of an addiction team? Alcoholism: Clinical and Experimental Research. 2017;41(1):165–170.
38. Singal AK, Chaha KS, Rasheed K, Anand BS. Liver transplantation in alcohol-related liver disease current status and controversies. World Journal of Gastroenterology. 2013;19(36):5953–5963.
39. Siu L, Foont J, Wands JR. Hepatitis C virus and alcohol. Seminars in Liver Disease. 2009 ;29(2):188–199.
40. Dong X, Liu H, Chen F, et al. MiR-214 promotes the alcohol-induced oxidative stress via down-regulation of glutathione reductase and cytochrome P450 in liver cells. Alcoholism: Clinical and Experimental Research. 2014;38(1):68–77.
41. Patek, Donohue TM., Jr Alcohol-induced steatosis in liver cells. World Journal of Gastroenterology. 2007;13(37):4974–4978.
42. European Association for the Study of the Liver. EASL clinical practical guidelines: Management of alcohol-related liver disease. Journal of Hepatology. 2012;57(2):399–420.
43. Frazier TH, Stocker AM, Kershner NA, et al. Treatment of alcohol-related liver disease. Therapeutic Advances in Gastroenterology. 2011;4(1):63–81
44. Fujita T, Soontrapa K, Ito Y, et al. Hepatic stellate cells relay inflammation signalling from sinusoids to parenchyma in mouse models of immune-mediated hepatitis. Hepatology . 2016;63(4):1325–1339.
45. Ganesan M, Natarajan SK, Zhang J, et al. Role of apoptotic hepatocytes in HCV dissemination: Regulation by acetaldehyde. American Journal of Physiology: Gastrointestinal and Liver Physiology. 2016;310(11): G930–G940.
46. Ganesan M, Zhang J, Bronich T, et al. Acetaldehyde accelerates HCV-induced impairment of innate immunity by suppressing methylation reactions in liver cells. American Journal of Physiology: Gastrointestinal and Liver Physiology. 2015;309(7): G566–G577.
47. Gitto S, Vitale G, Villa E, Andreone P. Update on alcohol and viral hepatitis. Journal of Clinical and Translational Hepatology. 2014;2(4):228–233.
48. Kang L, Chen X, Sebastian BM, et al. Chronic ethanol and triglyceride turnover in white adipose tissue in rats: Inhibition of the anti-lipolytic action of insulin after chronic ethanol contributes to increased triglyceride degradation. Journal of Biological Chemistry. 2007;282(39):28465–28473.
49. Zakhari S, Li TK. Determinants of alcohol use and abuse: Impact of quantity and frequency patterns on liver disease. Hepatology. 2007;46(6):2032–2039.
50. Kharbanda KK, Todero SL, Ward BW, et al. Betaine administration corrects ethanol-induced defective VLDL secretion. Molecular and Cellular Biochemistry. 2009;327(1–2):75–78.
51. Kirpich IA, Miller ME, Cave MC, et al. Alcohol-related liver disease: Update on the role of dietary fat. Biomolecules. 2016;6(1):1
52. Pati S, Swain S, Mahapatra S, Hussain MA, Pati S. Prevalence, pattern, and correlates of alcohol misuse among male patients attending rural primary care in India. J Pharm BioallSci 2017;9:66-72
53. Wang ZG, Dou XB, Zhou ZX, Song ZY. Adipose tissue-liver axis in alcohol-related liver disease. World Journal of Gastrointestinal Pathophysiology. 2016;7(1):17–26
54. Kim MS, Ong M, Qu X. Optimal management for alcohol-related liver disease: Conventional medications, natural therapy or combination? World Journal of Gastroenterology. 2016;22(1):8–23.
55. Seronello S, Montanez J, Presleigh K, et al. Ethanol and reactive species increase basal sequence heterogeneity of hepatitis C virus and produce variants with reduced susceptibility to antivirals. PLoS One. 2011;6(11):e27436.
56. Sofair AN, Barry V, Manos MM, et al. The epidemiology and clinical characteristics of patients with newly diagnosed alcohol-related liver disease: Results from population-based surveillance. Journal of Clinical Gastroenterology. 2010;44(4):301–307.
57. Girish N, Kavita R, Gururaj G, Benegal V. Alcohol use and implications for public health: Patterns of use in four communities. Indian J Community Med. 2010;35:238.
58. Ghosh S, Samanta A, Mukherjee S. Patterns of alcohol consumption among male adults at a slum in Kolkata, India. J Health Popul Nutr. 2012;30:73.
59. Kumar SG, Premarajan KC, Subitha L, Suguna E, Vinayagamoorthy, Kumar V. Prevalence and pattern of alcohol consumption using alcohol use disorders identification test (AUDIT) in rural Tamil Nadu. J ClinDiagn Res. 2013;7:1637–9.
60. Lakshmi A, Daisy D, Duttagupta, Lendi J, Padmanaban Drinking Habits, Health, Social and Behavioural Aspects of Alcohol Users in A Semi-Urban Population In Chennai. IOSR-JDMS. 2014;13:20–22.
61. Dewan G, Chowdhury FR. Alcohol use and alcohol use disorders in Bangladesh. Asia Pac J Med Toxicol. 2015;4:83–90.
62. Vidhukumar K, Nazeer E, Anil P. Prevalence and pattern of alcohol use in Kerala – A district-based survey. IJRSTAT. 2016;18:363–7.
63. Ramanan VV, Singh SK. A study on alcohol use and its related health and social problems in rural Puducherry, India. J Family Med Prim Care. 2016;5:804.
64. Manimunda SP, Sugunan AP, Thennarasu K, Pandian D, Pesala KS, Benegal V. Alcohol consumption, hazardous drinking, and alcohol dependency among the population of Andaman and Nicobar Islands, India. Indian J Public Health. 2017;61:105.
65. Bute J, Kori S, Arora VK, Sahasrabuddhe A. Prevalence and pattern of alcohol consumption among males attending primary health care setting using AUDIT in rural Indore, Madhya Pradesh, India. Int J Community Med Public Health. 2018;5:4461–9.
66. Eashwar VM, Gopalakrishnan S, Umadevi R, Geetha A. Epidemiology of alcohol consumption in an urban area of Kancheepuram district, Tamil Nadu. J Family Med Prim Care. 2019;8:1098–105.
67. Teli SA, Joshi Y. Prevalence of alcohol consumption in an urban population of Dehradun. Asian J Pharm Res. 2019;9:87–9.
68. Wangdi K, Jamtsho T. Prevalence and correlates of current alcohol use among Bhutanese adults: A nationally representative survey data analysis. Indian J Psychol Med. 2019;41:38
69. Gururaj G, Isaac MK. Psychiatric Epidemiology in India: Moving Beyond Numbers An Indian Perspective. New Delhi: Elsevier Publications; 1993. p. 37.
70. Bonu S, Rani M, Peters DH, Jha P, Nguyem SN. Does use of tobacco or alcohol contribute to impoverishment from hospitalisation costs in India? Health Policy Plan. 2005;20:41–9.
71. Benegal V, Velayudan A, Jain S. The social costs of alcoholism (Karnataka) NIMHANS J. 2000;18:67–76.
72. Wei X, Shi X, Zhong W, et al. Chronic alcohol exposure disturbs lipid homeostasis at the adipose tissue-liver axis in mice: Analysis of triacylglycerols using high-resolution mass spectrometry in combination with in vivo metabolite deuterium labeling. PLoS One. 2013;8(2):e55382.
73. Thursz M, Forrest E, Roderick P, et al. The clinical effectiveness and cost-effectiveness of Steroids Or Pentoxifylline for Alcoholic Hepatitis (STOPAH): A 2 × 2 factorial rando mised controlled trial. Health Technology Assessment. 2015;19(102):1–104.
74. Pathak OK, Paudel R, Panta OB, Pant HP, Giri BR, Adhikari B. Retrospective study of the clinical profile and prognostic indicators in patients of alcohol-related liver disease admitted to a tertiary care teaching hospital in Western Nepal. Saudi J Gastroenterol. 2009;15(3):171-175.
75. Nagamani R, Sakuntala. Clinical profile of alcohol-related liver disease patients in a tertiary care teaching hospital and its correlation with type of alcoholic beverage consumption. International Journal of Medical and Health Research Volume 2; Issue 6; June 2016; Page No. 12-14
76. Sarin SK, Malhotra V, Nayyar A, Sundaram KR, Broor SL. Profile of alcohol-related liver disease in an Indian hospital. A prospective analysis. Liver. 1988;8(3):132-137.
77. Khatroch, Shamsunder. Study of clinical and biochemical profile of acute alcohol-related liver disease in a teaching hospital in Telangana. International Journal of Advances in Medicine, [S.l.], v. 5, n. 4, p. 804-808, July 2018.
78. Phuntshochoden, Yadvendra singh Sirohi, Praveen kumarsharma, V k sashindaran, a study of clinical profile of alcohol-related liver disease and its relation to alcohol dependence syndrome, Indian journal of applied research: volume-8 | issue-6 | June-2018
79. Rishi, Jain AK, Nandy P. Study of clinical, laboratory, and upper gastrointestinal endoscopic profile in patients of alcohol-related liver disease in Sikkim. Med J DY Patil Vidyapeeth 2018;11:228-31
80. Sheshrao S Chavan, Siddheshvar V Birajdar, Nikhil R Pawar. Clinical profile of patients with alcohol use disorder. IAIM, 2018; 5(2): 48-56.
81. Ravindra K Hadakshi, DGaurav Modi. International Journal of Medical Science and Education Int. j.med. sci.Educ. July-September 2018; 5(3):364-368
82. Jeewan Kumar Mitra, PraneetAnsalMundu, Bindey Kumar, Rajendra Kumar Satapathy, Rashmi Sinha, Manish Kumar. Profile of alcohol-related liver disease in the population of Jharkhand: an insight into the realm of alcoholism from profligacy to burden. International Journal of Contemporary Medical Research 2017;4(3):770- 773.
83. Jawgam Umbon, Kalpana Niranjan. A study of clinical profile and prognostic indicators of alcohol-related liver disease in a tertiary care centre of northeast India. Journal of evidence-based medicine.4175-4180
84. NityaNand, Parveen Malhotra, Dipesh Kumar Dhoot. Clinical Profile of Alcohol-related liver disease in a Tertiary Care Centre and its Correlation with Type, Amount and Duration of Alcohol Consumption. June 2015 (63).
85. Swati Hegde, ArunVishnar, Girish B. Ramteke. Study of clinical and laboratory profile in alcohol-related liver disease with emphasis on renal function. Int Jour of research in med sci. 2015;2 (3)
86. Cabez J, bataller R. Alcohol-related liver disease: New UK alcohol guidelines and Dry January: enough to give up boozing? Nat Rev Gatroentrol Hepato 2016; 13:191.0
87. Torruellas C, French SW, Medici V. Diagnosis of alcohol-related liver disease. World J Gastroenterol. 2014;20(33):11684-11699.
88. Ray G, Manjubhargav P. Clinical Presentation and Mortality Determinants of Alcohol-Related Liver Disease: A Single-Center Experience of the Rising Menace from Eastern India. InflammIntest Dis. 2019;4(3):104-114.
89. Huang LL, Xia HH, Zhu SL. Ascitic Fluid Analysis in the Differential Diagnosis of Ascites: Focus on Cirrhotic Ascites. J ClinTranslHepatol. 2014;2(1):58-64.
90. O'Shea RS, Dasarathy S, McCullough AJ (January 2010). "Alcohol-related liver disease: AASLD Practice Guidelines" (PDF). Hepatology. 51 (1): 307–28.
91. Bruha R, Dvorak K, Petrtyl J. Alcohol-related liver disease. World J Hepatol. 2012;4(3):81-90.
92. Hasin DS, O'Brien CP, Auriacombe M, et al. DSM-5 criteria for substance use disorders: recommendations and rationale. Am J Psychiatry. 2013;170(8):834-851.
93. Schuppan D, Afdhal NH. Liver cirrhosis. Lancet. 2008;371(9615):838-851.
94. Gül F, Arslantaş MK, Cinel İ, Kumar A. Changing Definitions of Sepsis. Turk J AnaesthesiolReanim. 2017;45(3):129-138.
95. Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases. J Hepatol. 2014; 61: 642-659
96. Ng CK, Chan MH, Tai MH, Lam CW. Hepatorenal syndrome. ClinBiochem Rev. 2007;28(1):11-17.
97. Roth JA, Chrobak C, Schädelin S, Hug BL. MELD score as a predictor of mortality, length of hospital stay, and disease burden: A single-centre retrospective study in 39,323 inpatients. Medicine (Baltimore). 2017;96(24):e7155.
98. Kamath PS, Kim WR; Advanced Liver Disease Study Group. The model for end-stage liver disease (MELD). Hepatology. 2007 Mar;45(3):797-805.
99. Peng Y, Qi X, Guo X. Child-Pugh Versus MELD Score for the Assessment of Prognosis in Liver Cirrhosis: A Systematic Review and Meta-Analysis of Observational Studies. Medicine (Baltimore). 2016;95(8):e2877
100. Vignesh BT, Singh AK, Mohan SK, Murthy S, Joshi A. Association between socio-demographics and alcohol dependence among individuals living in an Indian setting. Glob J Health Sci. 2014;6(3):16-26.
101. MP Virukal pattigopalratnam, Anil Arora,S. Mukhewar .Socio economic and demographic profile of patients with alcohol-related liver disease in India. Journal of clinical and experimental hepatolog.2013;22-28
102. Narawane NM, Bhatia S, Abraham P, Sanghani S, Sawant SS. Consumption of 'country liquor' and its relation to alcohol-related liver disease in Mumbai. J Assoc Physicians India. 1998 Jun;46(6):510-3.
103. Askgaard G, Grønbæk M, Kjær MS, Tjønneland A, Tolstrup JS. Alcohol drinking pattern and risk of alcoholic liver cirrhosis: a prospective cohort study. J Hepatol. 2015 May;62(5):1061-7.
104. Bellentani S, Saccoccio G, Costa G, Tiribelli C, Manenti F, Sodde M, SaveriaCrocè L, Sasso F, Pozzato G, Cristianini G, Brandi G. Drinking habits as cofactors of risk for alcohol-induced liver damage. The Dionysos Study Group. Gut. 1997 Dec;41(6):845-50.
105. Kerr WC, Fillmore KM, Marvy P. Beverage-specific alcohol consumption and cirrhosis mortality in a group of English-speaking beer-drinking countries. Addiction. 2000 Mar;95(3):339-46.
106. Becker U, Deis A, Sørensen TI, Grønbaek M, Borch-Johnsen K, Müller CF, Schnohr P, Jensen G. Prediction of risk of liver disease by alcohol intake, sex, and age: a prospective population study. Hepatology. 1996 May;23(5):1025-9.
107. Savolainen. Oscar-Berman M, Marinkovic K. Alcohol: effects on neurobehavioral functions and the brain. Neuropsychol Rev. 2007;17(3):239-257.
108. Anand Roy N. Prevalence and determinants of co-use of alcohol and tobacco among men in the working-age group (18-59 years) in India. EpidemiolBiostat Public Health. 2016;13:804–08.
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Nov 11, 2025
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Dr. Prashanth.k, Dr Naman Bansal, Dr. Abhishek, & Dr. Bhuddi Prakash Meena. (2025). PROFILE OF ALCOHOL-RELATED LIVER DISEASE AMONG PATIENTS ATTENDING TERTIARY CARE HOSPITAL IN INDIA.(INSIGHTS FROM STUDY IN NORTHWESTERN INDIA. Journal of Population Therapeutics and Clinical Pharmacology, 32(10), 393-425. https://doi.org/10.53555/pc2w4w65
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Author Biographies
Dr. Prashanth.k
MBBS, MD (Internal Medicine), DM Resident (Medical Gastroenterology and Hepatology)
Dr Naman Bansal
MBBS, MD (1) DM Resident (Medical gastroenterology and Hepatology)
Dr. Abhishek
MBBS, MD DM RESIDENT (Medical Gastroenterology and Hepatology)
Dr. Bhuddi Prakash Meena
MD.DM Department of Gastroenterology and Hepatology, [NIMS&R], Jaipur, Rajasthan, India
How to Cite
Dr. Prashanth.k, Dr Naman Bansal, Dr. Abhishek, & Dr. Bhuddi Prakash Meena. (2025). PROFILE OF ALCOHOL-RELATED LIVER DISEASE AMONG PATIENTS ATTENDING TERTIARY CARE HOSPITAL IN INDIA.(INSIGHTS FROM STUDY IN NORTHWESTERN INDIA. Journal of Population Therapeutics and Clinical Pharmacology, 32(10), 393-425. https://doi.org/10.53555/pc2w4w65