Long-term outcome of decompensated alcohol-related liver disease with steatohepatitis and Maddrey’s discriminant function <32.,Journal of Hepatology

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Long-term outcome of decompensated alcohol-related liver disease with steatohepatitis and Maddrey’s discriminant function <32.
Journal of Hepatology ( IF 26.8 ) Pub Date : 2020-04-01 , DOI: 10.1016/j.jhep.2019.12.023
Delphine Degré ₁ , Rudolf E Stauber ₂ , Gaël Englebert ₁ , Francesca Sarocchi ₃ , Laurine Verset ₄ , Florian Rainer ₅ , Walter Spindelboeck ₅ , Hassane Njimi ₆ , Eric Trépo ₁ , Thierry Gustot ₁ , Carolin Lackner ₇ , Pierre Deltenre ₈ , Christophe Moreno ₉

Affiliation

Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; EASL Consortium for the Study of alcohol-related liver disease (SALVE).
Institute of Pathology, Medical University of Graz, Graz, Austria.
Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
Biomedical statistics, Université Libre de Bruxelles, Brussels, Belgium.
EASL Consortium for the Study of alcohol-related liver disease (SALVE); Institute of Pathology, Medical University of Graz, Graz, Austria.
Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; EASL Consortium for the Study of alcohol-related liver disease (SALVE); Department of Gastroenterology and Hepatology, Clinique St Luc, Bouge, Belgium.
Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; EASL Consortium for the Study of alcohol-related liver disease (SALVE).

BACKGROUND AND AIMS Patients with alcoholic hepatitis and a modified Maddrey's discriminant function (mDF) <32 have a low risk of short-term mortality. However, few data exist concerning long-term outcomes. The aims of this study were to evaluate 5-year survival rates and to identify predictive factors for long-term prognosis in this patient population. METHODS We studied patients from 2 centres who were admitted for hepatic decompensation (ascites, hepatic encephalopathy, or jaundice) and who had histological findings of steatohepatitis and an mDF <32. Clinical and biological parameters were recorded at the time of liver biopsy and alcohol consumption was recorded during follow-up. We performed Cox proportional hazard survival analysis to identify factors associated with 5-year survival. RESULTS One hundred and twenty-one patients were included (male: 64%, mean age: 51.5±10.3 years, presence of cirrhosis: 84%). The median MELD and mDF scores were 14 [25th-75th percentile: 11.7-16.1] and 19 [25th-75th percentile: 11.1-24], respectively. During follow-up, 30% of the patients remained abstinent. Survival rates at 1, 6, 12, 24, and 60 months were 96.7±1.6%, 90.1±2.7%, 80.8±3.6%, 69.9±4.3%, and 50.7±4.9%, respectively. The majority of deaths (80%) were liver-related. In multivariable analysis, encephalopathy at baseline and alcohol abstinence were predictive of 5-year survival. The 5-year survival rates of patients without and with encephalopathy at baseline were 60.5±5.8% and 29.7±8%, respectively, and the 5-year survival rates of abstinent and non-abstinent patients were 74.8± 8% and 40.9±.8%, respectively. CONCLUSIONS Mortality of patients with alcoholic hepatitis and an mDF <32 presenting with an acute decompensation is around 50% at 5 years. Hepatic encephalopathy at baseline and lack of alcohol abstinence impair long-term prognosis. New treatment strategies, including measures to ensure abstinence, are required.

中文翻译：

伴有脂肪性肝炎和 Maddrey 判别函数的失代偿性酒精相关肝病的长期结果 <32。

背景和目的酒精性肝炎和改良的 Maddrey 判别函数 (mDF) <32 的患者短期死亡风险较低。然而，关于长期结果的数据很少。本研究的目的是评估 5 年生存率并确定该患者群体长期预后的预测因素。方法我们研究了来自 2 个中心的患者，这些患者因肝功能失代偿（腹水、肝性脑病或黄疸）而入院，并且组织学发现脂肪性肝炎且 mDF <32。在肝活检时记录临床和生物学参数，并在随访期间记录饮酒量。我们进行了 Cox 比例风险生存分析，以确定与 5 年生存相关的因素。结果包括 121 名患者（男性：64%，平均年龄：51.5±10.3 岁，存在肝硬化：84%）。MELD 和 mDF 分数的中位数分别为 14 [25-75th 百分位数：11.7-16.1] 和 19 [25th-75th 百分位数：11.1-24]。在随访期间，30% 的患者仍然戒酒。1、6、12、24 和 60 个月的存活率分别为 96.7±1.6%、90.1±2.7%、80.8±3.6%、69.9±4.3% 和 50.7±4.9%。大多数死亡 (80%) 与肝脏有关。在多变量分析中，基线脑病和戒酒可预测 5 年生存率。基线时无脑病和有脑病患者的 5 年生存率分别为 60.5±5.8% 和 29.7±8%，禁欲和非禁欲患者的 5 年生存率分别为 74.8±8% 和 40.9±。 8%，分别。结论酒精性肝炎和 mDF <32 出现急性失代偿的患者的死亡率在 5 年时约为 50%。基线时的肝性脑病和缺乏戒酒会损害长期预后。需要新的治疗策略，包括确保禁欲的措施。

更新日期：2020-04-01

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