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Invasive aspergillosis in patients with severe alcoholic hepatitis

Thierry Gustot1, Evelyne Maillart2, Massimo Bocci3

  • 1Department of Gastroenterology and Hepato-Pancreatology, Erasme Hospital, Brussels, Belgium; Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Brussels, Belgium; INSERM, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Paris, France.

Journal of Hepatology
|September 24, 2013
PubMed
Abstract

Insights

Invasive aspergillosis (IA) is a frequent complication in severe alcoholic hepatitis (AH), significantly increasing mortality. Early screening for IA is crucial for improving outcomes in these high-risk patients.

Area of Science:

  • Hepatology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Severe alcoholic hepatitis (AH) presents a poor short-term prognosis.
  • Infections are common in AH, but the incidence and impact of invasive aspergillosis (IA) are unknown.

Purpose of the Study:

  • To determine the incidence of invasive aspergillosis (IA) in severe alcoholic hepatitis (AH).
  • To assess the impact of IA on the outcomes of patients with severe AH.

Main Methods:

  • Prospective follow-up of 94 patients with biopsy-proven severe AH for 3 months.
  • Retrospective review of IA diagnosis using EORTC/MSG and AspICU criteria.

Main Results:

  • Fifteen cases of IA were diagnosed a median of 26 days after AH diagnosis.
  • Independent risk factors for IA included MELD score ≥24 and ICU admission.
  • 3-month transplant-free survival was 0% for patients with IA versus 53% without IA.

Conclusions:

  • Invasive aspergillosis is a frequent and highly fatal complication of severe alcoholic hepatitis.
  • Systematic screening for IA is recommended in patients with severe AH.
  • Further research is needed to identify high-risk groups for antifungal prophylaxis.
Keywords:
ABICAHAUROCAge, serum Bilirubin, INR, and serum CreatinineAlcoholic hepatitisAspergillosisBALCSFCTCorticosteroidsGMIAICUINRInfectionLTMELDNPVPPVPTSBPalcoholic hepatitisarea under receiver operating characteristic curvebronchoalveolar lavagecerebrospinal fluidcomputed tomographygalactomannanintensive care unitinternational normalized ratioinvasive aspergillosisliver transplantationmDFmodel for end-stage liver diseasemodified discriminant functionnegative predictive valuepositive predictive valueprothrombin timespontaneous bacterial peritonitis

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