A Data-Driven Survival Analysis of Prognostic Determinants in Patients with Alcohol-Related Liver Disease: A Prospective Study

Klerida Shehu; Benard Shehu; Dorina Osmanaj; Erald Vasili; Matilda  Kambo; Andrin Tahiri; Esmeralda Thoma

doi:10.15157/ijitis.2026.9.1.25-50

Authors

Klerida Shehu 1. Department of Preclinical Sciences, University of Medicine, Tirana, Albania; 2. Division of Toxicology and Addiction Medicine, University Hospital Center “Mother Teresa”, Tirana, Albania https://orcid.org/0009-0005-7443-8368
Benard Shehu Cardiology Service, University Hospital Centre “Mother Teresa”, Tirana, Albania https://orcid.org/0009-0009-9250-1454
Dorina Osmanaj Division of Toxicology and Addiction Medicine, University Hospital Center “Mother Teresa”, Tirana, Albania https://orcid.org/0009-0000-7300-4975
Erald Vasili Radiology Department, Tirana Polyclinic, Tirana, Albania https://orcid.org/0009-0004-0602-2435
Matilda Kambo Division of Toxicology and Addiction Medicine, University Hospital Center “Mother Teresa”, Tirana, Albania https://orcid.org/0009-0000-1788-2554
Andrin Tahiri Division of Toxicology and Addiction Medicine, University Hospital Center “Mother Teresa”, Tirana, Albania https://orcid.org/0009-0001-8024-9433
Esmeralda Thoma 1. Department of Preclinical Sciences, University of Medicine, Tirana, Albania; 2. Division of Toxicology and Addiction Medicine, University Hospital Center “Mother Teresa”, Tirana, Albania https://orcid.org/0000-0001-8125-8318

DOI:

https://doi.org/10.15157/ijitis.2026.9.1.25-50

Keywords:

ALD, Prognosis, Survival Analysis, MELD, Abstinence

Abstract

Alcohol-related liver disease (ALD) is a leading cause of liver-related mortality in Europe, yet prospective survival data from Southeast Europe remain limited. Prognostic assessment has traditionally focused on biological disease severity, while behavioral factors particularly sustained alcohol abstinence is less consistently incorporated. It has been conducted a prospective observational cohort study of 200 adults with confirmed ALD treated at a national tertiary referral center in Albania and followed for 12 months. Sustained alcohol abstinence (≥6 months) was modelled dynamically as a time-varying exposure within an integrated biological–behavioral prognostic framework. Overall survival was evaluated using Kaplan–Meier analysis and Cox proportional hazards models, with liver transplantation treated as a censoring event; competing-risk models were applied to account for transplantation as a competing outcome. During follow-up, 44 patients (22%) died. Non-survivors had significantly higher Model for End-Stage Liver Disease (MELD) scores (21.0 ± 7.1 vs. 15.0 ± 6.2, p < 0.001) and a higher prevalence of ascites (77% vs. 46%, p = 0.002) and hepatic encephalopathy (52% vs. 19%, p < 0.001). Sustained abstinence was less frequent among non-survivors (20% vs. 46%, p = 0.013) and was associated with improved survival (log-rank p = 0.013). In multivariable Cox and competing-risk analyses, MELD, ascites, and hepatic encephalopathy independently predicted mortality, whereas time-varying abstinence demonstrated an independent protective effect. The combined biological–behavioral model showed good discrimination and calibration (optimism-corrected Harrell’s C-index 0.78–0.82; 12-month AUC ≈ 0.80). In this underrepresented Southeast European cohort, established severity markers remained dominant predictors of short-term mortality, while the dynamic incorporation of abstinence provided incremental prognostic value, supporting improved risk stratification and pragmatic ALD management in resource-limited settings.