Aa
Can anyone guess at prognosis for this cirrhosis having, still drinking, alcoholic?
Some background... Patient is my husband. He is 37 and a severe, life long alcoholic. He started drinking in his early teens and has been a drinker ever since. He has been a “functioning” alcoholic for the vast majority of this time; the only real consequence of his drinking being his failing health( and all that brings with it- job losses, lack of energy, horribleness all around) He has had no legal consequences and he is still able to intermittently hold down employment. This makes his justify his drinking to no end as he doesn’t see himself as meeting the criteria of a “severe” alcoholic.
He was diagnosed with alcoholic cirrhosis approximately two years ago after a couple stints in the ER for severe electrolyte imbalances, jaundice and malnutrition.Upon discharge he resumed drinking and ended up back in the ICU 9 months later- this time for bleeding varices, ascites, severe jaundice, very low clotting factors, alcohol withdrawal, electrolyte imbalances and HE. He was in the hospital ICU for about two weeks and in observation/ascites and electrolyte therapy another week.
He was warned that if he continued drinking he wouldn’t last much longer. His Child’s Pugh class is C and at the time of his discharge his MELD was 17. It’s was double that at admission.
This was about three months ago. He has since been on a daily regimen of Lactulose, Spironolactone, and Furosemide. It doesn’t appear that he is compliant with this regimen. Since he returned to work he has reduced his intake of the medications as he says they are disruptive to his meeting-heavy desk job. He no longer has visible ascites or odema. His Jaundice is pretty visible even with medication. He attended 2 weeks of a 30+ day rehab program after the hospitalization and imho is not complying with the AA requirements of the program.
As of a couple of weeks ago, he has returned to heavy drinking. His drink of choice is neat vodka in water bottles and he puts away no less than 750ml a day when actively drinking. He doesn’t appear to drink daily like he did at his worst;(as evidenced by the shakes) but he is definitely struggling to stay sober.
Given the severity of his illness( He was advised he should get on a transplant list but would need to pursue sobriety first); and the fact that he is still occasionally drinking, how much time does he have? I want to get my affairs in order ( Wills, life insurance, directives etc) because I fear the worst. He is only 37 however; and has beat three ICU stays with pretty severe symptoms and maybe could do this another 30 years (In which case I need to pursue divorce.) I do not want to add to the stress of a possibly dying man by pursuing divorce if I do not need to. But I do not want to continue living and raising kids with a self-destructive alcoholic either.
Is anyone able to determine how long he can continue this way? No doctor has given us an X amount of time estimate and since he goes back and forth between being sober and and being completely drunk, I really can’t decide what outcome is most likely. I hear abstinence can stop (reverse?) alcoholic cirrhosis so I do not know what effect his intermittent sobriety does or does not have.
Any clarification on how cirrhosis does or does not progress with compliance and what benefit if any sobriety provides to those with alcoholic cirrhosis will be helpful. In other words, if he takes his meds and stops drinking, what will likely happen next? On the other hand if he keeps drinking- while taking his medication occasionally; how soon does death become an outcome? Years? Decades?
He was diagnosed with alcoholic cirrhosis approximately two years ago after a couple stints in the ER for severe electrolyte imbalances, jaundice and malnutrition.Upon discharge he resumed drinking and ended up back in the ICU 9 months later- this time for bleeding varices, ascites, severe jaundice, very low clotting factors, alcohol withdrawal, electrolyte imbalances and HE. He was in the hospital ICU for about two weeks and in observation/ascites and electrolyte therapy another week.
He was warned that if he continued drinking he wouldn’t last much longer. His Child’s Pugh class is C and at the time of his discharge his MELD was 17. It’s was double that at admission.
This was about three months ago. He has since been on a daily regimen of Lactulose, Spironolactone, and Furosemide. It doesn’t appear that he is compliant with this regimen. Since he returned to work he has reduced his intake of the medications as he says they are disruptive to his meeting-heavy desk job. He no longer has visible ascites or odema. His Jaundice is pretty visible even with medication. He attended 2 weeks of a 30+ day rehab program after the hospitalization and imho is not complying with the AA requirements of the program.
As of a couple of weeks ago, he has returned to heavy drinking. His drink of choice is neat vodka in water bottles and he puts away no less than 750ml a day when actively drinking. He doesn’t appear to drink daily like he did at his worst;(as evidenced by the shakes) but he is definitely struggling to stay sober.
Given the severity of his illness( He was advised he should get on a transplant list but would need to pursue sobriety first); and the fact that he is still occasionally drinking, how much time does he have? I want to get my affairs in order ( Wills, life insurance, directives etc) because I fear the worst. He is only 37 however; and has beat three ICU stays with pretty severe symptoms and maybe could do this another 30 years (In which case I need to pursue divorce.) I do not want to add to the stress of a possibly dying man by pursuing divorce if I do not need to. But I do not want to continue living and raising kids with a self-destructive alcoholic either.
Is anyone able to determine how long he can continue this way? No doctor has given us an X amount of time estimate and since he goes back and forth between being sober and and being completely drunk, I really can’t decide what outcome is most likely. I hear abstinence can stop (reverse?) alcoholic cirrhosis so I do not know what effect his intermittent sobriety does or does not have.
Any clarification on how cirrhosis does or does not progress with compliance and what benefit if any sobriety provides to those with alcoholic cirrhosis will be helpful. In other words, if he takes his meds and stops drinking, what will likely happen next? On the other hand if he keeps drinking- while taking his medication occasionally; how soon does death become an outcome? Years? Decades?
There is no way to know. If he has a bleeding episode from esophageal varicies throwing up blood he could die right then and there or he could continue like this for many many years.
He could develop ascities and get spontaneous bacterial peritonitis (SPB) and pass away from infection. If he is not taking his lactulose he could develop sever HE and accidentally harm himself like if he was driving also HE can lead to coma and death.
Also people with cirrhosis are at increased risk of developing liver cancer (HCC) as a primary cancer. Liver cancer can be very aggressive and the person could die months after diagnosis.
There is no way to estimate how long he could continue like this but if he does not stop drinking he will die from one of the complications of liver cirrhosis.
They won’t let us post links but look up the American Liver Foundation they have a lot of information about liver disease.
I did find this
The Child-Pugh-Turcotte (CPT) classification system is a widely used and validated way to estimate prognosis in those with cirrhosis. A score of 5-6 is class A (life expectancy 15-20 years); a score of 7-9 is class B (life expectancy 4-14 years); a score of 10-15 is class C (life expectancy 1-3 years)
The child Pugh only goes up to C but the MELD goes as high as 40. Mist patients get transplanted at about 30 dilute to the availability of organs. There are at any given time 6,000 people on the liver transplant list and about 1,600 liver transplants performed annually. Many people die waiting for a liver. So this is why they won’t allow someone who is drinking and not medically compliant to be placed on the transplant list.
I am so sorry you are in this situation sending you my best hopes he stops drinking and slowly killing himself.
But yes you should probably take steps to get his affairs in order. Maybe having him pre arrange his own funeral might be a wake up call.
He could develop ascities and get spontaneous bacterial peritonitis (SPB) and pass away from infection. If he is not taking his lactulose he could develop sever HE and accidentally harm himself like if he was driving also HE can lead to coma and death.
Also people with cirrhosis are at increased risk of developing liver cancer (HCC) as a primary cancer. Liver cancer can be very aggressive and the person could die months after diagnosis.
There is no way to estimate how long he could continue like this but if he does not stop drinking he will die from one of the complications of liver cirrhosis.
They won’t let us post links but look up the American Liver Foundation they have a lot of information about liver disease.
I did find this
The Child-Pugh-Turcotte (CPT) classification system is a widely used and validated way to estimate prognosis in those with cirrhosis. A score of 5-6 is class A (life expectancy 15-20 years); a score of 7-9 is class B (life expectancy 4-14 years); a score of 10-15 is class C (life expectancy 1-3 years)
The child Pugh only goes up to C but the MELD goes as high as 40. Mist patients get transplanted at about 30 dilute to the availability of organs. There are at any given time 6,000 people on the liver transplant list and about 1,600 liver transplants performed annually. Many people die waiting for a liver. So this is why they won’t allow someone who is drinking and not medically compliant to be placed on the transplant list.
I am so sorry you are in this situation sending you my best hopes he stops drinking and slowly killing himself.
But yes you should probably take steps to get his affairs in order. Maybe having him pre arrange his own funeral might be a wake up call.
2 Comments
Thank you for the info!
That is disappointing ( that there’s no way to know).
I may have to go the severing all ties route as I cannot imagine living through more years of this.
The “scaring him straight” tactic hasn’t worked as the hospital we go to made him sign advance directives for his last hospital stay- and he is still drinking. He gets intermittent nose bleeds and that hasn’t stopped him. ( That was how his last episode of bleeding varices began before advancing to full on oral and rectal bleeding with vomiting)
Thank you for the info, I could use all the information I can get.
That is disappointing ( that there’s no way to know).
I may have to go the severing all ties route as I cannot imagine living through more years of this.
The “scaring him straight” tactic hasn’t worked as the hospital we go to made him sign advance directives for his last hospital stay- and he is still drinking. He gets intermittent nose bleeds and that hasn’t stopped him. ( That was how his last episode of bleeding varices began before advancing to full on oral and rectal bleeding with vomiting)
Thank you for the info, I could use all the information I can get.
However, long it takes him to have one of the life threatening symptoms of cirrhosis and not getting to emergency care quickly enough.
Without a crystal ball to know the future the statistical odds for a child Pugh “C” is 1 to 3 years but could be longer since 1 to 3 years is only an average.
This is why no doctor has given you an estimate. If he was diagnosed with liver cancer then they could be more specific like maybe 6 months or less. And even with a dire diagnosis some patients still beat the odds and hang on for a bit longer then predicated.
But when you have a medical condition that the prognosis is in more than just months there is just no way to know. No way to even guess.
Without a crystal ball to know the future the statistical odds for a child Pugh “C” is 1 to 3 years but could be longer since 1 to 3 years is only an average.
This is why no doctor has given you an estimate. If he was diagnosed with liver cancer then they could be more specific like maybe 6 months or less. And even with a dire diagnosis some patients still beat the odds and hang on for a bit longer then predicated.
But when you have a medical condition that the prognosis is in more than just months there is just no way to know. No way to even guess.
Have an Answer?
You are reading content posted in the Cirrhosis of the Liver Community
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.
