The Worsening Profile of Alcoholic Hepatitis in the United States. (5th May 2016)

• Record Type: Journal Article
• Authors: Nguyen, Tuyet A.; DeShazo, Jonathan P.; Thacker, Leroy R.; Puri, Puneet; Sanyal, Arun J.
• Is Part Of: Alcoholism. Volume 40:Number 6(2016)
• Page Start: 1295
• Page End: 1303
• Publication Date: 2016-05-05
• Subjects: Alcoholic Hepatitis -- Model for End‐Stage Liver Disease -- Lille Score -- Steroids -- Prednisolone -- Pentoxifylline -- Cirrhosis -- Alcohol‐Induced Cirrhosis -- Sepsis -- Liver Failure; Alcoholism -- Periodicals; Alcoholism -- Periodicals; Alcoolisme; Electronic journals; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.861005
• DOI: 10.1111/acer.13069
• Languages: English
• ISSNs: 0145-6008

Abstract

Abstract : Background: Alcoholic hepatitis (AH) is a major cause of liver‐related hospitalization. The profile, treatment patterns, and outcomes of subjects admitted for AH in routine clinical practice are unknown. Also, it is not known whether these are changing over time. This study is thus aimed to identify temporal trends in hospitalization rates, clinical characteristics, treatment patterns, and outcomes of subjects admitted for AH in a routine clinical setting. Methods: A retrospective analysis of adults admitted for AH from 2000 to 2011 was performed using an anonymized EMR database of patient‐level data from 169 U.S. medical centers. Results: (i) Epidemiology : The proportion of baby boomers admitted for AH increased from 2000 to 2011 (26 to 31%, p < 0.0001). (ii) Clinical : The median Model for End‐Stage Liver Disease (MELD) score increased over time from 12 to 14 ( p = 0.0014) driven mainly by increased international normalized ratio (1.2 to 1.4, p < 0.0001). The median Charlson Comorbidity Index increased from 0 to 1 ( p < 0.0001) with increased diabetes, chronic obstructive pulmonary disease, and heart disease. (iii) Complications : The following increased from 2001 to 2011: Gastrointestinal bleed—7 to 10% ( p = 0.03); hepatic encephalopathy—7 to 13% ( p < 0.0001); hepatorenal syndrome—1.8 to 2.8% ( p = 0.0003); sepsis—0 to 6% ( p < 0.0001); and pancreatitis—11 to 16% ( p = 0.0061). (iv) Treatment patterns and mortality : Eight to 9% of subjects received steroids while pentoxifylline use increased to 2.2%. In those with MELD ≥ 22, mortality remained between 19 and 20% and only steroids modestly improved survival in this subset. Conclusions: Severe AH continues to have a high mortality. The severity and comorbidities and complications associated with AH have worsened. Drug therapy remains suboptimal. Abstract : Trends for hospitalized alcoholic hepatitis (AH) patients from 2000 to 2011. Increasing admissions. On average 10 years younger compared to general admissions. About 3.5 times higher among 40–49 years age group. Increasing trend among baby boomers. Increasing median MELD score and higher proportion with MELD score >22 (severe AH). Increasing comorbidities and higher CCI scores. Response to prednisone and pentoxifylline treatment is suboptimal. Higher risk of death with increasing complications and old age. About 30% mortality even in moderate AH.