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[Severe alcoholic hepatitis in Japan].
Yoshinori Horie1, Hiromasa Ishii
1Department of Internal Medicine, School of Medicine, Keio University.
Summary
Severe alcoholic hepatitis patients with organ failure have a poor prognosis. Key indicators like high white blood cell counts and renal failure predict mortality, suggesting early intervention is crucial.
Area of Science:
- Hepatology
- Internal Medicine
- Critical Care Medicine
Context:
- Increasing alcohol consumption in Japan is linked to a rise in severe alcoholic hepatitis cases.
- Severe alcoholic hepatitis often presents with multiple organ failures, leading to a poor prognosis comparable to fluminant hepatitis.
Purpose:
- To identify prognostic factors determining the outcome of severe alcoholic hepatitis.
- To investigate correlations between clinical/laboratory data, organ failure, and patient survival.
Summary:
- Nationwide survey of hospitals in Japan identified factors associated with mortality in severe alcoholic hepatitis.
- Higher white blood cell counts, elevated serum creatinine, anemia, prolonged prothrombin time, infection, gastrointestinal bleeding, and disseminated intravascular coagulation were observed in non-survivors.
- Conversely, survivors had lower white blood cell counts, normal creatinine, higher red blood cell counts, and shorter prothrombin times.
Impact:
- Identifies critical indicators for predicting severe alcoholic hepatitis prognosis.
- Suggests early therapeutic interventions including plasma exchange, hemodialysis, and anticoagulation for high-risk patients.
- Highlights potential risks of corticosteroid therapy in patients with infection or bleeding, advocating for co-administration of antibacterial and gastroprotective agents.