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The prognosis for fatty change is good provided that drinking ceases or is controlled. Continued high alcohol consumption leaves the patient at risk of development of alcoholic cirrhosis.
Many patients with acute alcoholic hepatitis deteriorate rapidly and some 20-50% die. Resolution is slow even in those who abstain. A poor prognosis is associated with an increased prothrombin time, unresponsive to intramuscular vitamin K, and a raised serum bilirubin above 20 mg.
Alcoholic cirrhotics who continue to drink have a 30% 5-year survival; among abstainers, this improves to 70%. Ascites, jaundice and variceal haemorrhage are poor prognostic signs. Women survive less well than men.
Hepatocellular carcinoma complicates 10-15% of those with cirrhosis.
At least 25% of patients with ALD continue to consume alcohol irrespective of therapy.
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