Determinants of long‐term outcome in severe alcoholic hepatitis. Issue 6 (23rd July 2013)

• Record Type: Journal Article
• Authors: Potts, J. R.; Goubet, S.; Heneghan, M. A.; Verma, S.
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 38:Issue 6(2013)
• Page Start: 584
• Page End: 595
• Publication Date: 2013-07-23
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.12427
• Languages: English
• ISSNs: 0269-2813

Abstract

<abstract abstract-type="main" id="apt12427-abs-0001"> <title>Summary</title> <sec id="apt12427-sec-0001" sec-type="section"> <title>Background</title> <p>Although short‐term outcome in severe alcoholic hepatitis (SAH) is well described, its long‐term course remains uncharacterised.</p> </sec> <sec id="apt12427-sec-0002" sec-type="section"> <title>Aim</title> <p>To assess determinants of long‐term outcome in SAH.</p> </sec> <sec id="apt12427-sec-0003" sec-type="section"> <title>Methods</title> <p>Data were recorded from a cohort with SAH (admission Discriminant Function (DF) ≥32). Kaplan–Meier (KM) and Cox proportional hazards survival analyses were performed to determine predictors of outcome.</p> </sec> <sec id="apt12427-sec-0004" sec-type="section"> <title>Results</title> <p>One hundred and nine patients were included; 63.3% male, aged 49.6 ± 9.4 years with median follow‐up of 40.7 months (95% CI 37.2–44.3). Median DF was 58, 86.2% had cirrhosis and 65.1% received corticosteroids and/or pentoxifylline. Overall mortality was 57.8%, 96.8% of deaths being liver‐related and 65.1% occurring after the index hospitalisation. Estimated 5‐year survival was 31.8%. Hepatorenal syndrome was the only baseline factor independently associated with mortality (HR 3.78, 95% CI 1.98–7.19, <italic>P</italic> < 0.0001), although it predicted short‐term, rather than long‐term outcome (median survival 0.52 months, 95% CI 0.43–0.61). Of the 87 patients (79.8%) who survived index hospitalisation, 65.1% experienced recidivism. Abstinence at last follow‐up remained the only independent predictor of survival in multivariate analysis (HR 0.370, 95% CI 0.168–0.818, <italic>P</italic> = 0.014). Five‐year survival was higher in abstainers (75.3%) compared with relapsed and continued drinkers (26.8% and 21.0%, respectively, <italic>P</italic> = 0.005). However, the survival benefit from abstinence only became statistically significant at 18 months postdischarge (HR 2.714, 95% CI 0.995–7.404, <italic>P</italic> = 0.051).</p> </sec> <sec id="apt12427-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Estimated 5‐year survival after index hospitalisation with SAH is 31.8% with alcohol relapse occurring in two‐thirds of patients. Abstinence remains the only independent predictor of long‐term survival. Novel strategies to improve abstinence after admission with SAH are urgently needed.</p> </sec> </abstract>