Richard Parker1, Joaquin Cabezas2, Jose Altamirano3, Juan Pablo Arab4, Meritxell Ventura-Cots5, Ashish Sinha6, Ashwin Dhanda7, Marco Arrese8, C Anne McCune6, Ian A Rowe9, Bernd Schnabl10, Phillipe Mathurin11, Debbie Shawcross12, Juan G Abraldes13, Michael R Lucey14, Guadalupe Garcia-Tsao15, Elizabeth Verna16, Robert S Brown17, Francisco Bosques-Padilla18, Victor Vargas19, Alexandre Louvet16, Andrew P Holt20, Ramon Bataller5. 1. Leeds Liver Unit, St James's University Hospital, Leeds, United Kingdom. Electronic address: richardparker@nhs.net. 2. Department of Gastroenterology and Hepatology, University Hospital Marques de Valdecilla, Valdecilla Research Institute, Santander, Spain; Liver Center, Departments of Medicine and Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 3. Internal Medicine Department, Hospital Quirónsalud, Barcelona, Spain. 4. Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. 5. Center for Liver Diseases, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 6. Department of Liver Medicine, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom. 7. Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, United Kingdom. 8. Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Centro de Envejecimiento y Regeneración, Departamento de Biología Celular y Molecular, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile. 9. Leeds Liver Unit, St James's University Hospital, Leeds, United Kingdom. 10. Department of Medicine, VA San Diego Healthcare System, University of California, San Diego, La Jolla, California. 11. Service des Maladies de l'Appareil Digestif et Unité, French Institute of Health and Medical Research, Hôpital Huriez, Lille, France. 12. Liver Sciences, Dept of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom. 13. Cirrhosis Care Clinic, Division of Gastroenterology (Liver Unit), Centre of Excellence Gastrointestinal Inflammation and Immunity Research, University of Alberta, Edmonton, Alberta, Canada. 14. Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin. 15. Section of Digestive Diseases, Yale University, New Haven, Connecticut; Section of Digestive Diseases, VA Connecticut Healthcare System, West Haven, Connecticut. 16. Division of Digestive and Liver Diseases, Department of Medicine, Columbia College of Physicians and Surgeons, Columbia University Medical Center, New York, New York. 17. Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York. 18. Hospital San José Tecnológico de Monterrey. Universidad Autónoma de Nuevo León, Monterrey, México. 19. Liver Unit, Hospital Vall d'Hebron, Universitat Autònoma Barcelona, CIBEREHD, Barcelona, Spain. 20. Liver and Hepatobiliary Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
Abstract
BACKGROUND AND AIMS: Alcoholic hepatitis (AH) is a severe condition with poor short-term prognosis. Specific treatment with corticosteroids slightly improves short-term survival but is associated with infection and is not used in many centers. A reliable method to identify patients who will recover spontaneously will minimise the numbers of patients who experience side effects of available treatments. METHODS: We analysed the trajectory of serum bilirubin concentration over the course of hospital admissions in patients with AH to predict spontaneous survival and the need for treatment. RESULTS: data from 426 patients were analysed. Based on bilirubin trajectory, patients were categorized into three groups: 'fast fallers' (bilirubin <0.8 x admission value at day 7), 'static' (bilirubin of >0.9 - <1.2 x admission value) and 'rapid risers' (bilirubin of ≥1.2 x admission bilirubin). Fast fallers had significantly better 90-day survival compared to other groups (log rank p < .001), and showed no benefit of corticosteroid therapy (OR for survival at 28 days of treatment, 0.94, 95% CI 0.06 - 8.41). These findings remained even amongst patients with severe disease based on initial DF, GAHS or MELD scores. CONCLUSIONS: We present an intuitive method of classifying patients with AH based on the trajectory of bilirubin over the first week of admission. It is complimentary to existing scores that identify candidates for corticosteroid treatment or assess response to treatment. This method identifies a group of patients with AH who recover spontaneously and can avoid corticosteroid therapy.
BACKGROUND AND AIMS: Alcoholic hepatitis (AH) is a severe condition with poor short-term prognosis. Specific treatment with corticosteroids slightly improves short-term survival but is associated with infection and is not used in many centers. A reliable method to identify patients who will recover spontaneously will minimise the numbers of patients who experience side effects of available treatments. METHODS: We analysed the trajectory of serum bilirubin concentration over the course of hospital admissions in patients with AH to predict spontaneous survival and the need for treatment. RESULTS: data from 426 patients were analysed. Based on bilirubin trajectory, patients were categorized into three groups: 'fast fallers' (bilirubin <0.8 x admission value at day 7), 'static' (bilirubin of >0.9 - <1.2 x admission value) and 'rapid risers' (bilirubin of ≥1.2 x admission bilirubin). Fast fallers had significantly better 90-day survival compared to other groups (log rank p < .001), and showed no benefit of corticosteroid therapy (OR for survival at 28 days of treatment, 0.94, 95% CI 0.06 - 8.41). These findings remained even amongst patients with severe disease based on initial DF, GAHS or MELD scores. CONCLUSIONS: We present an intuitive method of classifying patients with AH based on the trajectory of bilirubin over the first week of admission. It is complimentary to existing scores that identify candidates for corticosteroid treatment or assess response to treatment. This method identifies a group of patients with AH who recover spontaneously and can avoid corticosteroid therapy.
Authors: David W Crabb; Ramon Bataller; Naga P Chalasani; Patrick S Kamath; Michael Lucey; Philippe Mathurin; Craig McClain; Arthur McCullough; Mack C Mitchell; Timothy R Morgan; Laura Nagy; Svetlana Radaeva; Arun Sanyal; Vijay Shah; Gyongyi Szabo Journal: Gastroenterology Date: 2016-02-24 Impact factor: 22.682
Authors: G Y Im; L Kim-Schluger; A Shenoy; E Schubert; A Goel; S L Friedman; S Florman; T D Schiano Journal: Am J Transplant Date: 2015-12-28 Impact factor: 8.086
Authors: Kevin P Moore; Florence Wong; Pere Gines; Mauro Bernardi; Andreas Ochs; Francesco Salerno; Paolo Angeli; Michael Porayko; Richard Moreau; Guadelupe Garcia-Tsao; Wladimiro Jimenez; Ramon Planas; Vicente Arroyo Journal: Hepatology Date: 2003-07 Impact factor: 17.425