Gene signature‐MELD score and alcohol relapse determine long‐term prognosis of patients with severe alcoholic hepatitis. (15th October 2019)

• Record Type: Journal Article
• Authors: Deltenre, Pierre; Trépo, Eric; Fujiwara, Naoto; Goossens, Nicolas; Marot, Astrid; Dubois, Margaux; Spahr, Laurent; Henrion, Jean; Moreno, Christophe; Hoshida, Yujin
• Is Part Of: Liver international. Volume 40:Number 3(2020)
• Page Start: 565
• Page End: 570
• Publication Date: 2019-10-15
• Subjects: cirrhosis -- MELD -- prognosis; Liver -- Periodicals; Liver -- Diseases -- Periodicals; 616.362
• DOI: 10.1111/liv.14265
• Languages: English
• ISSNs: 1478-3223

Abstract

Abstract: Background: The gene‐signature‐model for end stage liver disease (gs‐MELD) score has been shown to be a strong predictor of 6‐month survival in severe alcoholic hepatitis (AH). Currently, only a few studies have evaluated the long‐term prognosis of patients with severe AH. Aim: To assess the prognostic value of the gs‐MELD score at 5 years in patients with severe AH. Methods: Forty‐eight consecutive patients with AH (25 males, median age 52 years [95% IC: 48‐56]) were included. Results: The median gs‐MELD score was 2.6 (95% CI: 2.2‐3.0). According to the gs‐MELD score, 22 patients (46%) were considered to have a poor prognosis. During a median follow‐up of 29 months (95% CI: 4‐43), 19 patients (40%) were abstinent and 24 patients (50%) died. At 5 years, rates of survival were 61% (95% CI: 41‐81) and 26% (95% CI: 11‐55) in patients with low and high gs‐MELD scores ( P = .001), and 81% (95% CI: 58‐96) and 22% (95% CI: 10‐47) in abstainers and in consumers ( P < .001) respectively. In multivariable competing risk regression modelling, gs‐MELD score (subdistribution hazard ratio: 5.78, 95% CI: 2.17‐15.38, P < .001) and recurrent alcohol consumption (subdistribution hazard ratio: 12.18, 95% CI: 3.16‐46.95, P < .001) were independently associated with 5‐year mortality. Conclusions: Both gs‐MELD score and alcohol consumption drive AH long‐term prognosis. The gs‐MELD score may guide the development of molecularly targeted therapies in AH. Abstract : See Editorial on Page 511