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Alcohol-Related Liver Disease: Diagnosis, Treatment, and Management

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: 20 February 2026 | Viewed by 5594

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Special Issue Editors

Dr. Adrian Boicean

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Guest Editor

Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
Interests: alcohol-related liver disease; E.R.C.P.; E.U.S.; gastric and colorectal cancer; pancreatic disease; fecal microbiota transplantation; inflammatory bowel disease; micro-RNA

Dr. Cristian Ichim

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Guest Editor

Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
Interests: liver cirrhosis; fecal microbiota transplantation; E.R.C.P.; colorectal cancer; E.U.S.; micro-RNA; pancreatic cancer

Special Issue Information

Dear Colleagues,

Hepatic pathology remains a cornerstone in medical research, offering vast opportunities for innovation and discovery. Despite significant advancements recently, numerous critical questions remain, which require the concentrated efforts of the scientific community to answer. Alcoholic liver disease, probably the most widespread chronic liver condition globally, impacts a substantial patient population. Many individuals seek medical attention only when severe complications arise, which can lead to irreversible damage or even death. This places considerable strain on healthcare systems, underscoring the urgent need for accessible, cost-effective diagnostic tools and treatments capable of halting disease progression and promoting full recovery.

The effective management of liver disease yields extensive benefits, improving outcomes for patients, easing the burden on healthcare professionals and systems, and positively impacting society as a whole. These considerations highlight the need for thorough investigation and further research into the multifaceted challenges posed by alcohol-related liver disease.

We eagerly anticipate your valuable contributions and will facilitate meaningful dialogue that inspires transformative advancements in gastroenterology.

Dr. Adrian Boicean
Dr. Cristian Ichim
Guest Editors

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Keywords

alcohol-related liver disease
gut–liver axis
hepatic fibrosis
liver cirrhosis
micro-RNA
inflammatory pathways
liver transplantation
steatohepatitis
fecal microbiota transplantation in liver cirrhosis

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Published Papers (4 papers)

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Research

17 pages, 1329 KB

Open AccessArticle

Alcoholic Liver Disease and Systemic Inflammatory Response Syndrome: Mortality Prediction Using Biomarkers and Clinical Scores

by Tijana Glisic, Bojan Korica, Milica Stojkovic Lalosevic, Nevena Baljosevic, Jasna El Mezeni, Marko Kartal, Dusan Dj Popovic, Jelena Martinov Nestorov, Snezana Lukic and Dragana Mijac

J. Clin. Med. 2025, 14(21), 7580; https://doi.org/10.3390/jcm14217580 - 25 Oct 2025

Viewed by 494

Abstract

Background/Objectives: Cirrhosis is an irreversible state of chronic liver disease. Systemic inflammatory response syndrome (SIRS) is a severe complication and significantly contributes to lethal outcomes in cirrhotic patients. We studied a group of cirrhotic patients with SIRS admitted to our centre, assessing the relationship with in-hospital outcomes. Methods: The study population included 102 patients with alcoholic cirrhosis and SIRS. Laboratory biomarkers, the model for end-stage liver disease, the model for end-stage liver disease—natrium, the Acute Physiology and Chronic Health Evaluation II score, CLIF-C organ failure, the systemic immune-inflammation index score (S II), and the Cirrhosis Acute Gastrointestinal Bleeding (CAGIB) score were tested in relation to the mortality risk using receiver operating characteristic (ROC) curves. Results: Our results demonstrated that values of sodium, chlorides, and albumin significantly correlated with 7-day survival. The area under the curve’s (AUCs) values for sodium, chlorides, and albumin were 0.542, 0.627, and 0.610, respectively, for 7-day mortality prediction. The CAGIB score significantly correlated with 7-day mortality, with the cut-off value of −7.86 (AUC: 0.674, 95% CI (0.555–0.794)). For the assessment of 28-day mortality, the AUC values for sodium, chlorides, and albumin were 0.630, 0.654, and 0.661, respectively. Additionally, the cut-off value of the CAGIB score was found to be −7.84 (AUC: 0.625, 95% CI (0.509–0.740)) in 28-day mortality prediction. Conclusions: Sodium, chlorides, albumin, and the CAGIB score are reliable predictors of 7-day and 28-day in-hospital mortality in patients with advanced alcoholic liver disease and SIRS. Full article

(This article belongs to the Special Issue Alcohol-Related Liver Disease: Diagnosis, Treatment, and Management)

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21 pages, 1731 KB

Open AccessArticle

Sepsis Drives Severity and Mortality in Acute-on-Chronic Liver Failure Among ICU Patients with Alcohol-Related Cirrhosis: A Retrospective Single-Center Study

by Elena von Maldeghem, Katharina Zimmermann, Patricia Mester, Vlad Pavel, Georgios Athanasoulas, Lea Kirsch, David Kolben, Sophia Rusch, Sophie Schlosser-Hupf, Martina Müller and Stephan Schmid

J. Clin. Med. 2025, 14(19), 7025; https://doi.org/10.3390/jcm14197025 - 3 Oct 2025

Viewed by 1332

Abstract

Background/Objectives: Acute-on-chronic liver failure (ACLF) is a life-threatening complication of cirrhosis, characterized by organ failures and high short-term mortality. Alcohol-related cirrhosis is one of the most frequent underlying etiologies of ACLF in Europe. Infections, particularly those leading to sepsis are recognized triggers; however, their relative contribution, clinical features, and prognostic impact in critically ill patients with alcohol-related cirrhosis remain incompletely defined. This study aimed to systematically identify and characterize precipitating events of ACLF in this population and to compare outcomes between sepsis- and non-sepsis-related cases. Methods: We conducted a retrospective cohort study including 188 ICU patients with alcohol-related cirrhosis who were treated for ACLF at a tertiary university medical center. ACLF was defined and graded according to the European Association for the Study of the Liver—Chronic Liver Failure Consortium (EASL-CLIF) criteria, and sepsis was diagnosed according to Sepsis-3 definitions. Clinical data, precipitating events, microbiological evidence, organ support requirements, and in-hospital outcomes were systematically analyzed. Results: Sepsis was the most frequent precipitating event, identified in 118 patients (62.8%), while 70 patients (37.2%) developed ACLF due to non-septic triggers such as gastrointestinal bleeding. Patients with sepsis-associated ACLF presented with more advanced disease (ACLF grade 2–3 in 80.5% vs. 57.1%, p = 0.004), higher Chronic Liver Failure Consortium—Acute-on-Chronic Liver Failure Score (CLIF-C ACLF) scores (median 55 vs. 50, p = 0.04), longer ICU stays (median 11 vs. 4.5 days, p < 0.001), and markedly higher in-hospital mortality (60.2% vs. 20.0%, p < 0.001) compared to patients without sepsis. Pneumonia (48.3%), urinary infections (17.8%) and spontaneous bacterial peritonitis (16.1%) were the leading infectious foci triggering sepsis. Microbiological evidence was obtained in 82.2% of sepsis cases, with frequent polymicrobial infections and opportunistic pathogens including Enterococcus faecium and Candida albicans. Conclusions: In critically ill patients with alcohol-related cirrhosis, infections leading to sepsis are the predominant precipitating event of ACLF and the strongest determinant of short-term prognosis. Compared with non-sepsis triggers, sepsis-associated ACLF is characterized by more severe disease, greater need for organ support, longer ICU stays, and substantially higher mortality. These findings highlight the urgent need for early recognition, rapid diagnostic strategies, and optimized infection management to improve outcomes in this high-risk population. Full article

(This article belongs to the Special Issue Alcohol-Related Liver Disease: Diagnosis, Treatment, and Management)

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16 pages, 2053 KB

Open AccessArticle

Chronic and Heavy Drinking, Nutrition Status, and Progression of Liver Injury Negatively Affect the Mortality Risk in Patients Suffering from Alcohol-Associated Hepatitis

by Aishwarya Thakurdesai, Anjali Kumari, Henry Shay, Khaled Elgharabawy, Evan J. Winrich, Wanyu Zhang, Amber Jackson, Matthew C. Cave, Maiying Kong, Xiang Zhang, Ashwani K. Singal, Craig J. McClain and Vatsalya Vatsalya

J. Clin. Med. 2025, 14(17), 6157; https://doi.org/10.3390/jcm14176157 - 31 Aug 2025

Viewed by 1268

Abstract

Background/Objectives: Alcohol-associated hepatitis (AH) is an acute inflammatory condition of alcohol-associated liver disease (ALD) with rapid progression and high mortality. The Age-Bilirubin-INR-Creatinine (ABIC) score is a static algorithm that predicts survivability in AH. The roles of alcohol drinking patterns and nutritional status in AH progression and risk of death are understudied. This study evaluates the impact of alcohol drinking patterns and nutrition on AH progression and mortality. Methods: Sixty-one adult patients diagnosed with AH were stratified by the Model for End-Stage Liver Disease (MELD) as non-severe (MELD < 20, n = 26, Gr.1) and severe (MELD ≥ 20, n = 35, Gr.2). Each group was further subdivided by ABIC: low- (<6.71), intermediate- (6.71–9), and high- (>9) risk categories. We assessed different demographics: nutrition using the Controlling Nutritional Status (CONUT) score; lifetime drinking history (LTDH); recent alcohol use (AUDIT); laboratory measures (complete metabolic panel, complete blood count, and coagulation), and clinical measures (Maddrey DF, Child–Turcotte–Pugh, and Lille). Results: All patients showed a significant and positive correlation between ABIC and LTDH (r = 0.538, p = 0.004), particularly in Gr.2 (r = 0.554, p = 0.011). The low-risk Gr.2 exhibited the highest AST:ALTs. AST:ALTs were significantly associated with LTDH, AUDIT, and CONUT (R² = 0.539, p = 0.031). In all AH patients with intermediate mortality risk, AST:ALTs were strongly linked to CONUT and LTDH (R² = 0.657, p = 0.017). Conclusions: Severe AH demonstrates rapid liver injury progression even when the mortality risk is low. Chronic and recent heavy alcohol consumption and poor nutrition adversely impact AH severity and mortality risk. Alcohol intake and nutritional assessments in routine clinicals could identify high-risk patients, thereby improving treatment and a favorable prognosis. Full article

(This article belongs to the Special Issue Alcohol-Related Liver Disease: Diagnosis, Treatment, and Management)

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18 pages, 943 KB

Open AccessArticle

Fecal Microbiota Transplantation in Patients with Alcohol-Associated Cirrhosis: A Clinical Trial

by Cristian Ichim, Adrian Boicean, Samuel Bogdan Todor, Paula Anderco and Victoria Bîrluțiu

J. Clin. Med. 2025, 14(17), 5981; https://doi.org/10.3390/jcm14175981 - 24 Aug 2025

Cited by 1 | Viewed by 2018

Abstract

Background: Gut microbiota dysregulation is increasingly recognized as a key contributor to the progression of liver cirrhosis and its complications, particularly hepatic encephalopathy. Fecal microbiota transplantation (FMT) has emerged as a novel therapeutic strategy aimed at restoring intestinal microbial homeostasis and modulating systemic inflammation. Methods: This prospective, single-center clinical trial evaluated the short-term safety and efficacy of FMT in patients with alcohol-related liver cirrhosis. Clinical assessment, liver stiffness (via elastography), steatosis (controlled attenuation parameter), inflammatory biomarkers, and extended biochemical panels were analyzed at baseline, one week and one month post-FMT. A control group receiving standard medical therapy was used for comparison. Results: FMT was associated with a significant reduction in hepatic encephalopathy severity (p = 0.014), sustained improvements in liver stiffness (p = 0.027) and decreased steatosis (p = 0.025). At one month, C-reactive protein and neutrophil-to-lymphocyte ratio both declined significantly (p = 0.043), indicating a measurable anti-inflammatory effect. No serious adverse events were recorded. In comparison with controls, FMT recipients showed lower systemic inflammation and improved neuropsychiatric status. Conclusions: FMT demonstrated a favorable safety profile and yielded early clinical and biochemical benefits in patients with cirrhosis. These preliminary findings support the potential utility of microbiota-based interventions in chronic liver disease and warrant validation in larger, multicenter trials. Full article

(This article belongs to the Special Issue Alcohol-Related Liver Disease: Diagnosis, Treatment, and Management)

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