Portal hypertension in alcohol-associated hepatitis: harmless and the reflection of systemic inflammation?

• Severe portal hypertension does not predict 6-month survival in. • Liver/spleen ratio is a key marker of severe portal hypertension in alcohol-associated hepatitis. • Persistent portal hypertension is driven by systemic inflammation, not alcohol abstinence. • Leukocyte count predicts the persistence of portal hypertension at 6 months. • Dynamic inflammation reshapes portal hypertension progression in severe hepatitis. Portal hypertension is a prominent feature of alcohol-associated hepatitis. However, it is not established whether the severity of PH has a prognostic impact in AH. The aim of our study was to assess the impact of PH on 6-month transplantation-free survival (TFS). A monocentric retrospective analysis was conducted on patients with symptomatic AH, proven histologically, admitted in our tertiary care hospital from January 2013 to December 2021. 127 patients were included in the study, with a mean Discriminant Function and MELD score of 59.5 (±23.5) and 25.2 (±6.6), respectively. The only risk factor for severe PH at admission was the liver/spleen ratio. Patients were followed up for a median of 20 months. The median TFS was 16.8 months. Severe PH was not significantly associated with 6-month TFS, unlike the MELD score and nonresponse to corticosteroids. In addition, the leucocyte count was associated with persistent PH at 6 months. In our study, severe PH had no impact on 6-month TFS. Further investigations on the prognostic value of PH and its natural history in AH are warranted.