Background & Aims
All trials on severe alcoholic hepatitis (AH) have included patients with “pure” AH,
i.e., without concomitant gastrointestinal bleeding (GIB). Severe AH is often suspected
in cirrhotic patients with GIB.
We aimed at (1) assessing the prevalence of AH in patients with GIB and Maddrey discriminant
function (DF) ⩾32; (2) comparing the outcome in AH patients with or without GIB (AH-GIB+,
AH-GIB−); and (3) assessing the performance of the Lille model for survival in AH-GIB+
patients.
Methods
We retrospectively included all patients with alcoholic cirrhosis admitted between
January 2005 and March 2011 with the following: (1) jaundice <3 months; (2) DF ⩾32 at admission; (3) bilirubin level >50 μmol/L; and (4) active drinking. Exclusion criteria were advanced hepatocellular carcinoma,
other etiology of cirrhosis, severe comorbidities and DF <32 after stabilization.
In our centre, we systematically plan a liver biopsy for these patients. Patients
with severe AH received prednisolone.
Results
We screened 161 patients (86 GIB+, 75 GIB−), and analyzed data for 58 and 47 patients
in each group, respectively. The 2 groups did not differ in prevalence of AH (77.3%
vs. 81%), demographic data, MELD/Child-Pugh score, or DF. The 2 groups were similar in
6-month probability of survival (73.9 ± 6.0% vs. 69.9 ± 7%, p = 0.49). The probability of developing infection was lower for AH-GIB+ patients (24.1%
vs. 44.7%, p = 0.04). The AUC for the Lille model in predicting 6-month survival was 0.71 ± 0.06 for all patients and 0.74 ± 0.06 for AH-GIB+ patients (p >0.05).
Conclusions
Prevalence of AH is 80% for patients with cirrhosis and GIB, recent jaundice and DF
⩾32. Infection was lower for AH-GIB+ patients, which suggests a beneficial role of
antibiotic prophylaxis treatment. Survival among subjects with GIB was the same as
among subjects without GIB.
Abbreviations:
AH (alcoholic hepatitis), GIB (gastrointestinal bleeding), DF (Maddrey discriminant function), RCTs (randomized controlled trials), INR (International Normalized Ratio)Keywords
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References
- A randomized trial of prednisolone in patients with severe alcoholic hepatitis.N Engl J Med. 1992; 326: 507-512
- AASLD practice guidelines. Alcoholic liver disease.Hepatology. 2010; 1: 307-328
- Short-term and long-term survival in patients with alcoholic hepatitis treated with oxandrolone and prednisolone.N Engl J Med. 1984; 311: 1464-1470
- Methylprednisolone therapy in patients with severe alcoholic hepatitis. A randomized multicenter trial.Ann Intern Med. 1989; 110: 685-690
- Short- and long-term outcome of severe alcohol-induced hepatitis treated with steroids or enteral nutrition: a multicenter randomized trial.Hepatology. 2000; 32: 36-42
- Antioxidants versus corticosteroids in the treatment of severe alcoholic hepatitis – A randomised clinical trial.J Hepatol. 2006; 44: 784-790
- Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis: meta-analysis of individual patient data.Gut. 2011; 60: 255-260
- Infection in patients with severe alcoholic hepatitis treated with steroids: early response to therapy is the key factor.Gastroenterology. 2009; 137: 541-548
- Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension.J Hepatol. 2010; 53: 762-768
- Histologic spectrum of alcoholic liver disease.Semin Liver Dis. 1986; 6: 221-232
- Liver perfusion in sepsis, septic shock, and multiorgan failure.Anat Rec (Hoboken). 2008; 291: 714-720
- Early liver transplantation for severe alcoholic hepatitis.N Engl J Med. 2011; 365: 179-800
Article info
Publication history
Published online: November 10, 2014
Accepted:
November 2,
2014
Received in revised form:
October 14,
2014
Received:
March 10,
2014
See Editorial, pages 759–760Identification
Copyright
© 2015 European Association for the Study of the Liver. Published by Elsevier Inc. All rights reserved.
