Moderate alcohol-associated hepatitis: A real-world multicenter study
Por:
Idalsoaga, F, Díaz, LA, Dunn, W, Mehta, H, Muñoz, K, Caldentey, V, Arnold, J, Ayares, G, Mortuza, R, Sarin, SK, Maiwall, R, Zhang, W, Qian, S, Simonetto, D, Singal, AK, Elfeki, MA, Ramirez-Cadiz, C, Malhi, G, Ahmed, A, Homsi, H, Abid, Z, Cabezas, J, Echavarría, V, Poca, M, Soriano, G, Cuyas, B, Cots, MV, Higuera-De La Tijera, MF, Ayala-Valverde, M, Perez, D, Gomez, J, Abraldes, JG, Al-Karaghouli, M, Jalal, PK, Ibrahim, MA, García-Tsao, G, Goyes, D, Skladany, L, Havaj, DJ, Sulejova, K, Selcanova, SA, Rincón, D, Chacko, KR, Restrepo, JC, Yaquich, P, Toro, LG, Shah, V, Arrese, M, Kamath, PS, Bataller, R, Arab, JP
Publicada:
1 abr 2025
Resumen:
Background:Severe alcohol-associated hepatitis (sAH) is a well-characterized disease with high short-term mortality. However, there is limited research on those with a "less severe condition" (moderate AH). This study aims to characterize in-depth patients with moderate AH (mAH), including the performance of mortality scoring systems, key prognostic factors, and survival over time. Methods:A multicenter retrospective cohort study (2009-2019) included patients with mAH (MELD score <= 20 at admission). Cox regression and receiver operating characteristic curves with AUC were used for analysis. Results:We included 1845 patients with AH (20 centers, 8 countries) between 2009 and 2019. mAH was defined as a MELD score <= 20 at admission. Twenty-four percent met the criteria for an mAH episode. Patients with mAH tend to be older and have a higher proportion of females, with a median MELD of 17 (15-19), Maddrey discriminant function (mDF) of 33 (22-40), the trajectory of serum bilirubin of 0.83 (0.60-1.21), and neutrophil-to-lymphocyte ratio (NLR) of 5 (2.96-8.60). The primary causes of death in mAH included multiple organ failure (34.1%) and infections (16.6%). The cumulative survival rates at 30, 90, and 180 days were 94.3%, 90.4%, and 88.2%, respectively. In multivariable analysis, age was the only significant predictor of 30-day mortality (HR 1.49, 95% CI: 1.27-1.76, p<0.001). Mortality prediction models showed poor performance, with AUC for MELD (0.671), mDF (0.726), trajectory of serum bilirubin (0.733), and NLR (0.697). Conclusions:Patients with moderate AH exhibited a mortality of 11.8% at 6 months, primarily driven by multiple organ failure and infections. These patients also exhibit a different clinical profile compared to those with sAH. Tailored models and therapeutic strategies are needed to improve long-term outcomes in mAH.
Filiaciones:
Idalsoaga, F:
Pontificia Univ Catolica Chile, Escuela Med, Dept psiquiatria, Santiago, Chile
Western Univ, Dept Med, Div Gastroenterol & Hepatol, London, ON, Canada
London Hlth Sci Ctr, London, ON, Canada
Díaz, LA:
Pontificia Univ Catolica Chile, Escuela Med, Dept psiquiatria, Santiago, Chile
Univ Calif San Diego, MASLD Res Ctr, Div Gastroenterol & Hepatol, San Diego, CA USA
Dunn, W:
Univ Kansas, Med Ctr, Dept Med, Div Gastroenterol, Kansas City, KS USA
Mehta, H:
Univ Kansas, Med Ctr, Dept Med, Div Gastroenterol, Kansas City, KS USA
Muñoz, K:
Pontificia Univ Catolica Chile, Escuela Med, Santiago, Chile
Caldentey, V:
Pontificia Univ Catolica Chile, Escuela Med, Santiago, Chile
Arnold, J:
Pontificia Univ Catolica Chile, Escuela Med, Dept psiquiatria, Santiago, Chile
Ayares, G:
Western Univ, Dept Med, Div Gastroenterol & Hepatol, London, ON, Canada
London Hlth Sci Ctr, London, ON, Canada
Mortuza, R:
Western Univ, Dept Med, Div Gastroenterol & Hepatol, London, ON, Canada
London Hlth Sci Ctr, London, ON, Canada
Sarin, SK:
Inst Liver & Biliary Sci, Dept Hepatol, New Delhi, India
Maiwall, R:
Inst Liver & Biliary Sci, Dept Hepatol, New Delhi, India
Zhang, W:
Harvard Med Sch, Massachusetts Gen Hosp, Dept Med, Neuroendocrine Unit, Boston, MA 02114 USA
Qian, S:
Univ Florida, Dept Med, Div Gastroenterol Hepatol & Nutr, Gainesville, FL USA
Simonetto, D:
Mayo Clin, Dept Med, Div Gastroenterol & Hepatol, Rochester, MN USA
Singal, AK:
Univ Louisville, Sch Med, Dept Med Hepatol & Nutr, Div Gastroenterol, Louisville, KY USA
Elfeki, MA:
Univ Louisville, Sch Med, Dept Med Hepatol & Nutr, Div Gastroenterol, Louisville, KY USA
Ramirez-Cadiz, C:
Virginia Commonwealth Univ, Sch Med, Dept Anesthesiol, Richmond, VA USA
Malhi, G:
Western Univ, Dept Med, Div Gastroenterol & Hepatol, London, ON, Canada
London Hlth Sci Ctr, London, ON, Canada
Ahmed, A:
Western Univ, Dept Med, Div Gastroenterol & Hepatol, London, ON, Canada
London Hlth Sci Ctr, London, ON, Canada
Homsi, H:
Western Univ, Dept Med, Div Gastroenterol & Hepatol, London, ON, Canada
London Hlth Sci Ctr, London, ON, Canada
Abid, Z:
Western Univ, Dept Med, Div Gastroenterol & Hepatol, London, ON, Canada
London Hlth Sci Ctr, London, ON, Canada
Cabezas, J:
Univ Hosp Marques de Valdecilla, Gastroenterol & Hepatol Dept, Santander, Spain
Res Inst, Santander, Spain
Echavarría, V:
Univ Hosp Marques de Valdecilla, Gastroenterol & Hepatol Dept, Santander, Spain
Res Inst, Santander, Spain
Poca, M:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Inst Invest Biomed St Pau IIB St PAU, Dept Gastroenterol,CIBERehd, Barcelona, Spain
Soriano, G:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Inst Invest Biomed St Pau IIB St PAU, Dept Gastroenterol,CIBERehd, Barcelona, Spain
Cuyas, B:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Inst Invest Biomed St Pau IIB St PAU, Dept Gastroenterol,CIBERehd, Barcelona, Spain
Higuera-De La Tijera, MF:
Univ Nacl Autonoma Mexico, Hosp Gen Mexico, Fac Estudios Super Iztacala, Mexico City 54090, MEX, Mexico
Ayala-Valverde, M:
Hosp El Pino, Serv Med Interna, Santiago, Chile
Perez, D:
Hosp El Pino, Serv Med Interna, Santiago, Chile
Gomez, J:
Hosp El Pino, Serv Med Interna, Santiago, Chile
Abraldes, JG:
Univ Alberta, Dept Med, Div Gastroenterol, Liver Unit, Edmonton, AB, Canada
Al-Karaghouli, M:
Univ Alberta, Dept Med, Div Gastroenterol, Liver Unit, Edmonton, AB, Canada
Jalal, PK:
Baylor Coll Med, Dept Gastroenterol & Hepatol, Houston, TX USA
Ibrahim, MA:
Baylor Coll Med, Dept Gastroenterol & Hepatol, Houston, TX USA
García-Tsao, G:
Yale Univ, Sch Med, Sch Med, VA CTt Healthcare Syst, West Haven, CT 06520 USA
Goyes, D:
Yale Univ, Sch Med, Sch Med, VA CTt Healthcare Syst, West Haven, CT 06520 USA
Skladany, L:
Slovak Med Univ, F D Roosevelt Univ Hosp, Dept Internal Med 2, Div Hepatol Gastroenterol & Liver Transplantat, Banska Bystrica, Slovakia
Havaj, DJ:
Slovak Med Univ, F D Roosevelt Univ Hosp, Dept Internal Med 2, Div Hepatol Gastroenterol & Liver Transplantat, Banska Bystrica, Slovakia
Sulejova, K:
Slovak Med Univ, F D Roosevelt Univ Hosp, Dept Internal Med 2, Div Hepatol Gastroenterol & Liver Transplantat, Banska Bystrica, Slovakia
Selcanova, SA:
Slovak Med Univ, F D Roosevelt Univ Hosp, Dept Internal Med 2, Div Hepatol Gastroenterol & Liver Transplantat, Banska Bystrica, Slovakia
Rincón, D:
Univ Gregorio Maranon, CiberEHD, Dept Digest Dis, Hosp Gen, Madrid, Spain
CIBEREHD Ctr Invest Biomed Red Enfermedades Hepat, Madrid, Spain
Chacko, KR:
Montefiore Med Ctr, Dept Med, Div Hepatol, Bronx, NY USA
Restrepo, JC:
Univ Antioquia, Unidad Hepatol Hosp Pablo Tobon Uribe, Grp Gastrohepatol, Grp Gastrohepatol, Medellin, Colombia
Yaquich, P:
Hosp San Juan Dios, Santiago, Chile
Toro, LG:
Hosp San Vicente Fdn, Transplant, Medellin, Colombia
Shah, V:
Mayo Clin, Dept Med, Div Gastroenterol & Hepatol, Rochester, MN USA
Arrese, M:
Pontificia Univ Catolica Chile, Escuela Med, Dept psiquiatria, Santiago, Chile
Kamath, PS:
Mayo Clin, Dept Med, Div Gastroenterol & Hepatol, Rochester, MN USA
Bataller, R:
Hosp Clin Barcelona, Liver Unit, Barcelona, Spain
Inst Invest Biomed August Pi I Sunyer IDIBAPS, Barcelona, Spain
Arab, JP:
Pontificia Univ Catolica Chile, Escuela Med, Dept psiquiatria, Santiago, Chile
Virginia Commonwealth Univ, Sch Med, Dept Internal Med, Div Gastroenterol Hepatol & Nutr, Richmond, VA USA
Univ Autonoma Barcelona, Liver Unit, Hosp Vall dHebron, CIBERehd, Ciberehd, Barcelona, Spain
Green Submitted, gold
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