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Prognosis of treated severe alcoholic hepatitis in patients with gastrointestinal bleeding
Marika Rudler1, Sarah Mouri1, Frédéric Charlotte2
1AP-HP, UPMC, Department of Hepatogastroenterology, La Pitié-Salpêtrière Hospital, 47-80 boulevard de l'Hôpital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie University, 75013 Paris, France.
Insights
Severe alcoholic hepatitis (AH) occurs in 80% of cirrhotic patients with gastrointestinal bleeding (GIB). Outcomes and survival are similar between AH patients with or without GIB, with lower infection rates in those with GIB.
Area of Science:
- Hepatology
- Gastroenterology
- Internal Medicine
Background:
- Severe alcoholic hepatitis (AH) trials typically exclude patients with gastrointestinal bleeding (GIB).
- AH is often suspected in cirrhotic patients presenting with GIB.
- Previous research has not fully characterized AH in the context of GIB.
Purpose of the Study:
- Assess AH prevalence in cirrhotic patients with GIB and Maddrey discriminant function (DF) ≥32.
- Compare outcomes between AH patients with (AH-GIB+) and without (AH-GIB-) GIB.
- Evaluate the Lille model's performance for predicting survival in AH-GIB+ patients.
Main Methods:
- Retrospective analysis of cirrhotic patients admitted between 2005-2011.
- Inclusion criteria: jaundice <3 months, DF ≥32, bilirubin >50 μmol/L, active drinking.
- Exclusion criteria: HCC, other cirrhosis etiologies, severe comorbidities, DF <32 post-stabilization. Liver biopsy performed systematically; severe AH patients received prednisolone.
Main Results:
- AH prevalence was high (~80%) in both GIB+ and GIB- groups.
- No significant differences in demographics, MELD/Child-Pugh scores, or DF between groups.
- 6-month survival rates were similar (73.9% vs. 69.9%).
- Infection rates were lower in AH-GIB+ patients (24.1% vs. 44.7%).
- Lille model showed good predictive performance (AUC 0.71-0.74).
Conclusions:
- AH prevalence is approximately 80% in cirrhotic patients with GIB, jaundice, and DF ≥32.
- AH patients with GIB have similar survival rates to those without GIB.
- Lower infection rates in AH-GIB+ patients may suggest a benefit from antibiotic prophylaxis.
Background & Aims:
All trials on severe alcoholic hepatitis (AH) have included patients with "pure" AH, i.e., without concomitant gastrointestinal bleeding (GIB). Severe AH is often suspected in cirrhotic patients with GIB. We aimed at (1) assessing the prevalence of AH in patients with GIB and Maddrey discriminant function (DF) ⩾32; (2) comparing the outcome in AH patients with or without GIB (AH-GIB+, AH-GIB-); and (3) assessing the performance of the Lille model for survival in AH-GIB+ patients.
Methods:
We retrospectively included all patients with alcoholic cirrhosis admitted between January 2005 and March 2011 with the following: (1) jaundice <3 months; (2) DF ⩾32 at admission; (3) bilirubin level >50 μmol/L; and (4) active drinking. Exclusion criteria were advanced hepatocellular carcinoma, other etiology of cirrhosis, severe comorbidities and DF <32 after stabilization. In our centre, we systematically plan a liver biopsy for these patients. Patients with severe AH received prednisolone.
Results:
We screened 161 patients (86 GIB+, 75 GIB-), and analyzed data for 58 and 47 patients in each group, respectively. The 2 groups did not differ in prevalence of AH (77.3% vs. 81%), demographic data, MELD/Child-Pugh score, or DF. The 2 groups were similar in 6-month probability of survival (73.9 ± 6.0% vs. 69.9 ± 7%, p=0.49). The probability of developing infection was lower for AH-GIB+ patients (24.1% vs. 44.7%, p=0.04). The AUC for the Lille model in predicting 6-month survival was 0.71 ± 0.06 for all patients and 0.74 ± 0.06 for AH-GIB+ patients (p>0.05).
Conclusions:
Prevalence of AH is 80% for patients with cirrhosis and GIB, recent jaundice and DF ⩾32. Infection was lower for AH-GIB+ patients, which suggests a beneficial role of antibiotic prophylaxis treatment. Survival among subjects with GIB was the same as among subjects without GIB.
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