PDF | https://doi.org/10.46613/congastro2023-14
This work is licensed under CC BY 4.0
Idalsoaga F1, Díaz L1, Corsi O1, Ayares G1, Arnold J1, Dunn W2, Li Y2, Singal A3, Simonetto D4, Ayala-Valverde M5, Ramirez C6, Morales-Arraez D7, Zhang W8, Qian S8, Ahn J4, Buryska S4, Mehta H2, Waleed M3, Stefanescu H9, Horhat A9, Bumbu A9, Attar B10, Agrawal R11, Cabezas J12, Cuyàs B13, Poca M13, Soriano Pastor G13, Sarin S14, Maiwall R14, Jalal P15, Higuera-De La Tijera M16, Kulkarni A17, Rao P N17, Guerra Salazar P18, Skladaný L19, Bystrianska N19, Prado V20, Clemente-Sanchez A21, Rincón D21, Haider T22, Chacko K22, Romero G23, Pollarsky F23, Restrepo J24, Toro L25, Yaquich P26, Mendizabal M27, Garrido M28, Marciano S29, Dirchwolf M30, Vargas V31, Jimenez C31, García-Tsao G32, Ortiz G32, Abraldes J33, Kamath P4, Arrese M34, Shah V4, Bataller R35, Arab J36
1Departmento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile., Santiago, Chile
2University of Kansas Medical Center, KS, USA, Kansas, Estados Unidos (EEUU)
3Division of Gastroenterology and Hepatology, Department of Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA, Sioux Falls, Estados Unidos (EEUU)
4Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA, Rochester, Estados Unidos (EEUU)
5Hospital el Pino, Santiago, Chile
6Department of Anesthesia, Schulich School of Medicine, Western University & London Health Sciences Centre, London, Ontario, Canada.., London Ontario, Canadá
7Center for Liver Diseases, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, PA, USA., Pittsburgh, Estados Unidos (EEUU)
8Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA, Gainesville, Estados Unidos (EEUU)
9Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania, Cluj-Napoca, Rumania
10Division of Gastroenterology & Hepatology, Cook County Health and Hospital Systems, Chicago, Illinois, USA, Chicago, Estados Unidos (EEUU)
11Division of Gastroenterology and Hepatology, University of Illinois, Chicago, Illinois, USA, Chicago, Estados Unidos (EEUU)
12Gastroenterology and Hepatology Department. University Hospital Marques de Valdecilla. Santander. Spain; Research Institute Valdecilla (IDIVAL). Santander. Spain;, Santander, España
13Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, CIBERehd, Barcelona, Spain., Barcelona, España
14Institute of Liver and Biliary Sciences, New Delhi, India, New Delhi, India
15Department of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA, Houston, Estados Unidos (EEUU)
16Servicio de Gastroenterología, Hospital General de México, Universidad Nacional Autónoma de México, México., Mexico DF, México
17Asian Institute of Gastroenterology, Hyderabad, India, Hyderabad, India
18Instituto de Gastroenterología Boliviano-Japonés, La Paz, Bolivia, La Paz, Bolivia
19Division of Hepatology, Gastroenterology and Liver Transplantation, Department of Internal Medicine II, Slovak Medical University, F. D. Roosevelt University Hospital, Banska Bystrica, Slovak Republic, Banska Bystrica, República Checa
20Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg, Luxemburgo
21Liver Unit, Department of Digestive Diseases Hospital General Universitario Gregorio Marañón Madrid, Spain, Madrid, España
22Division of Gastroenterology and Hepatology, Montefiore Medical Center, Bronx, NY, USA, Bronx, Estados Unidos (EEUU)
23Sección Hepatología, Hospital de Gastroenterología Dr. Carlos Bonorino Udaondo, Buenos Aires, Argentina., Buenos Aire, Argentina
24Hospital Pablo Tobon Uribe, Universidad de Antioquia, Medellín, Colombia, Medellín, Colombia
25Hospitales de San Vicente Fundación, Medellín-Rionegro, Antioquia, Colombia, Antioquia, Colombia
26Departamento de Gastroenterología, Hospital San Juan de Dios, Santiago, Chile, Santiago, Chile
27Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Buenos Aires, Argentina, Buenos Aires, Argentina
28Hospital Central San Luis, San Luis, Argentina, San Luis, Afganistán
29Liver Unit, Hospital Italiano De Buenos Aires, Buenos Aires, Argentina., Buenos Aires, Argentina
30Unidad de Hígado, Hospital Privado de Rosario, Rosario, Argentina., Rosario, Argentina
31Liver Unit, Hospital Vall d’Hebron, Universitat Autonoma Barcelona, CIBEREHD, Barcelona, Spain., Barcelona, España
32Section of Digestive Diseases, Yale University School of Medicine/VA-CT Healthcare System, New Haven/West Haven, USA, New Haven/West Haven, Estados Unidos (EEUU)
33Division of Gastroenterology, Liver Unit, University of Alberta, Edmonton, Canada, Edmonton, Canadá
34Department of Gastroenterology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile., Santiago, Chile
35Liver Unit, Hospital Clinic, Barcelona, Barcelona, España
36Division Of Gastroenterology, Department Of Medicine, Schulich School Of Medicine, Western University & London Health Sciences Centre, London, Ontario, Canada., London, Ontario, Canadá
BACKGROUND: Alcohol-associated hepatitis (AH) corresponds a entity with high short-term mortality; however, few studies have been published in patients with moderate AH.
AIM: Characterize patients with moderate AH, identifying prognostic factors and survival at 30, 90, and 180 days.
METHODS: Multi-center retrospective cohort-study, which included patients with moderate AH (2009-2019). Moderate AH was defined as MELD≤20 at presentation. We used competing-risk models with liver transplantation as a competing risk to assess variables associated with mortality.
RESULTS:We included 564 patients with moderate AH(24 centers,12 countries). Median age was 48±11.6 years, 29.2% female, and 46.2.5% Caucasian. 51.7% of the cohort had cirrhosis, and 1.4% underwent liver transplantation. MELD score on admission was 17 [6-20] and 37.7% used corticosteroids during hospitalization. ​​Survival rates at 30, 90, and 180 days were 93.7% (0.911–0.955), 89.1% (0.860–0.916), and 87% (0.836–0.898), respectively. The most frequent causes of death were multiple organ failure (30.4%) and infections (11.5%). In the univariate analysis, the variables associated with mortality were age (sHR1.035, 95%CI:1.020–1.049; p<0.001), Maddrey’s discriminant function (sHR1.013, 95%CI:1.007–1.020; p<0.001), albumin at admission (sHR0.837, 95%CI:0.682–1.026; p=0.087), INR (sHR1.534; 95%CI: 1.070–2.198, p=0.020), renal replacement therapy (sHR7.066; 95%CI:4.381–11.392; p<0.001) and infections during hospitalization (sHR2.079; 95%CI:1.308–3.306; p=0.002)(Table). However, in the multivariate-adjusted model, only age (sHR 1.042; 95%CI:1.019–1.0656, p<0.001), RRT (sHR7.796; 95%CI:3.993–15.218, p<0.001) and infections during hospitalization (sHR1.666; 95%CI:0.999–2.779; p=0.050) were associated with mortality. The corticosteroids did not demonstrate benefit in moderate AH.
CONCLUSIONS: Patients with moderate AH have a significant mortality at short-term. Infections are associated with higher mortality and are the most important cause of death. Better models are necessary to predict mortality in moderate AH.
