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ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 37 Issue 2
Mar.  2021
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Article Navigation >  Journal of Clinical Hepatology  > 2021  >  37(2): 370-374

Evaluation and influencing factors of the short-term prognosis of severe alcoholic hepatitis with different underlying liver diseases

DOI: 10.3969/j.issn.1001-5256.2021.02.024
  • 1.

    Department of Hepatology and Gastroenterology, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin Key Laboratory of Artificial Cells, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Tianjin Third Central Hospital, Tianjin 300170, China

  • 2.

    Department of Gastroenterology, The First Hospital of Shanxi Medical University, Taiyuan 030001, China

  • Received Date: 2020-07-13
  • Accepted Date: 2020-10-13
  • Published Date: 2021-02-20
    Abstract
  •   Objective  To investigate the clinical features of patients with severe alcoholic hepatitis (AH) with different underlying liver diseases and the influencing factors for short-term prognosis.  Methods  A retrospective analysis was performed for the clinical data of 170 patients with severe AH who were admitted to Tianjin Third Central Hospital from August 2004 to August 2018, and according to the underlying liver disease, they were divided into group A (27 patients without liver cirrhosis), group B (52 patients with compensated liver cirrhosis), and group C (91 patients with decompensated liver cirrhosis). Related scores were calculated, including Maddrey's discriminant function (MDF) score, Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA) score, Model for End-Stage Liver Disease (MELD) score, age-bilirubin-international normalized ratio-creatinine (ABIC) score, and Glasgow alcoholic hepatitis score (GAHS). An analysis of variance or the Kruskal-Wallis H test was used for comparison of continuous data between multiple groups, and the chi-square test was used for comparison of categorical data between multiple groups. Univariate and multivariate Cox regression analyses were used to screen out the independent influencing factors for the short-term prognosis of patients with severe AH. The Kaplan-Meier method was used to plot survival curves, and the log-rank test was used for comparison of survival rate between groups. The receiver operating characteristic (ROC) curve was used to calculate the area under the ROC curve (AUC) and 95% confidence interval (CI), sensitivity, and specificity for each predictive model, and the DeLong method was used for comparison.  Results  The 28-day survival rates of patients in groups A, B, and C were 88.9%, 80.8%, and 51.6%, respectively, with a significant difference between the three groups (χ2=19.83, P < 0.001). The AUCs (95% CIs) of MELD score, MDF score, GAHS score, ABIC score, and CLIF-SOFA score were 0.584 (0.493-0.676), 0.696 (0.605-0.786), 0.644 (0.554-0.735), 0.745 (0.662-0.827), and 0.795 (0.726-0.863), respectively, in predicting 28-day mortality rate, and there were significant differences between CLIF-SOFA score and MDF, MELD, and GAHS scores (all P < 0.05); CLIF-SOFA score had a sensitivity of 79.0% and a specificity of 67.9% at the optimal cut-off value of 8.50 points in predicting 28-day mortality rate. Different underlying liver diseases (hazard ratio [HR]=2.296, 95% CI: 1.356-3.887, P=0.002) and hepatic encephalopathy (HR=1.911, 95% CI: 1.059-3.449, P=0.031) at disease onset were risk factors for 28-day prognosis.  Conclusion  Patients with severe AH with different underlying liver diseases have different clinical features and short-term prognoses. Different underlying liver diseases and hepatic encephalopathy at disease onset are closely associated with the 28-day prognosis of patients with severe AH. CLIF-SOFA score can predict the 28-day prognosis of patients with severe AH.

     

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    • References(19)
  • [1]
    O'SHEA RS, DASARATHY S, McCULLOUGH AJ, et al. Alcoholic liver disease[J]. Hepatology, 2010, 51(1): 307-328. DOI: 10.1002/hep.23258
    [2]
    ZHAI QH, SONG FJ, XU TJ, et al. Nutritional status of 156 patients with severe alcoholic liver disease[J/CD]. Chin J Liver Dis (Electronic Version), 2020, 12(1): 44-49. (in Chinese)

    翟庆慧, 宋芳娇, 徐天娇, 等. 156例重症酒精性肝病患者营养现况调查[J/CD].中国肝脏病杂志(电子版), 2020, 12(1): 44-49.
    [3]
    SANDAHL TD, JEPSEN P, THOMSEN KL, et al. Incidence and mortality of alcoholic hepatitis in Denmark 1999-2008: A nationwide population based cohort study[J]. J Hepatol, 2011, 54(4): 760-764. DOI: 10.1016/j.jhep.2010.07.016
    [4]
    SINGAL AK, BATALLER R, AHN J, et al. ACG clinical guideline: Alcoholic liver disease[J]. Am J Gastroenterol, 2018, 113(2): 175-194. DOI: 10.1038/ajg.2017.469
    [5]
    Cooperative Group of Alcoholic Liver Disease. A multicenter study of alcoholic liver disease in China[J]. Chin J Dig, 2007, 27(4): 231-234. (in Chinese) DOI: 10.3760/j.issn:0254-1432.2007.04.005

    全国酒精性肝病调查协作组.全国酒精性肝病的多中心调查分析[J].中华消化杂志, 2007, 27(4): 231-234. DOI: 10.3760/j.issn:0254-1432.2007.04.005
    [6]
    HMOUD BS, PATEL K, BATALLER R, et al. Corticosteroids and occurrence of and mortality from infections in severe alcoholic hepatitis: A meta-analysis of randomized trials[J]. Liver Int, 2016, 36(5): 721-728. DOI: 10.1111/liv.12939
    [7]
    LOUVET A, WARTEL F, CASTEL H, et al. Infection in patients with severe alcoholic hepatitis treated with steroids: Early response to therapy is the key factor[J]. Gastroenterology, 2009, 137(2): 541-548. DOI: 10.1053/j.gastro.2009.04.062
    [8]
    JENNE CN, KUBES P. Immune surveillance by the liver[J]. Nat Immunol, 2013, 14(10): 996-1006. DOI: 10.1038/ni.2691
    [9]
    DIRCHWOLF M, RUF AE. Role of systemic inflammation in cirrhosis: From pathogenesis to prognosis[J]. World J Hepatol, 2015, 7(16): 1974-1981. DOI: 10.4254/wjh.v7.i16.1974
    [10]
    THURSZ M, FORREST E, RODERICK P, et al. The clinical effectiveness and cost-effectiveness of STeroids Or Pentoxifylline for Alcoholic Hepatitis (STOPAH): A 2×2 factorial randomised controlled trial[J]. Health Technol Assess, 2015, 19(102): 1-104. DOI: 10.3310/hta191020
    [11]
    VERGIS N, ATKINSON SR, KNAPP S, et al. In patients with severe alcoholic hepatitis, prednisolone increases susceptibility to infection and infection-related mortality, and is associated with high circulating levels of bacterial DNA[J]. Gastroenterology, 2017, 152(5): 1068-1077. DOI: 10.1053/j.gastro.2016.12.019
    [12]
    FORREST EH, ATKINSON SR, RICHARDSON P, et al. Application of prognostic scores in the STOPAH trial: Discriminant function is no longer the optimal scoring system in alcoholic hepatitis[J]. J Hepatol, 2018, 68(3): 511-518. DOI: 10.1016/j.jhep.2017.11.017
    [13]
    SANDAHL TD, VILSTRUP H, JEPSEN P. The long-term prognosis of alcoholic hepatitis is poor and independent of disease severity for patients surviving an acute episode[J]. J Hepatol, 2018, 68(6): 1330-1331. DOI: 10.1016/j.jhep.2018.02.025
    [14]
    HERNAEZ R, SOLÀ E, MOREAU R, et al. Acute-on-chronic liver failure: An update[J]. Gut, 2017, 66(3): 541-553. DOI: 10.1136/gutjnl-2016-312670
    [15]
    MEHTA G, MOOKERJEE RP, SHARMA V, et al. Systemic inflammation is associated with increased intrahepatic resistance and mortality in alcohol-related acute-on-chronic liver failure[J]. Liver Int, 2015, 35(3): 724-734. DOI: 10.1111/liv.12559
    [16]
    MICHELENA J, ALTAMIRANO J, ABRALDES JG, et al. Systemic inflammatory response and serum lipopolysaccharide levels predict multiple organ failure and death in alcoholic hepatitis[J]. Hepatology, 2015, 62(3): 762-772. DOI: 10.1002/hep.27779
    [17]
    WANG BY. Importance of the clinical research on alcoholic hepatitis[J]. J Clin Hepatol, 2019, 35(3): 469-471. (in Chinese) DOI: 10.3969/j.issn.1001-5256.2019.03.002

    王炳元.重视酒精性肝炎的临床研究[J].临床肝胆病杂志, 2019, 35(3): 469-471. DOI: 10.3969/j.issn.1001-5256.2019.03.002
    [18]
    SERSTÉ T, CORNILLIE A, NJIMI H, et al. The prognostic value of acute-on-chronic liver failure during the course of severe alcoholic hepatitis[J]. J Hepatol, 2018, 69(2): 318-324. DOI: 10.1016/j.jhep.2018.02.022
    [19]
    KIM HY, KIM CW, KIM TY, et al. Assessment of scoring systems for acute-on-chronic liver failure at predicting short-term mortality in patients with alcoholic hepatitis[J]. World J Gastroenterol, 2016, 22(41): 9205-9213. DOI: 10.3748/wjg.v22.i41.9205
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