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Meta-Analysis: Mortality Trends and Risk Factors in Severe Alcohol-Associated Hepatitis.

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  • 1Department of Internal Medicine, Jamaica Hospital Medical Center, New York, USA.

Alimentary Pharmacology & Therapeutics
|September 20, 2025
PubMed
Summary

Short-term mortality for severe alcohol-associated hepatitis (sAH) remains high, with no significant improvement over the last four decades. This underscores the critical need for novel treatments and better prognostic tools for sAH patients.

Keywords:
alcoholalcoholic cirrhosisalcoholic hepatitisalcoholic liver diseasealcohol‐associated liver diseasemeta analysismortalitysystematic review

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Area of Science:

  • Hepatology
  • Clinical Medicine
  • Public Health

Background:

  • Severe alcohol-associated hepatitis (sAH) is a critical, life-threatening liver condition.
  • Prognosis for sAH patients remains poor despite clinical advancements.
  • The long-term efficacy of current sAH therapies is not well-established.

Purpose of the Study:

  • To systematically review and analyze short-term mortality trends (28, 60, 90 days) in sAH over five decades.
  • To identify changes and patterns in sAH mortality rates over time.
  • To evaluate the impact of clinical management on sAH outcomes.

Main Methods:

  • A systematic literature search was conducted across PubMed, EMBASE, and Scopus up to February 2024.
  • Pooled mortality estimates were calculated using random-effects meta-regression and Bayesian models.
  • Heterogeneity was assessed using I² statistics, with subgroup and meta-regression analyses performed.

Main Results:

  • 34 studies with 1586 sAH patients were analyzed.
  • Pooled 28, 60, and 90-day mortality rates were 26.8%, 35.1%, and 43.7%, respectively.
  • Despite a decline in early mortality post-2000, no statistically significant improvement in overall short-term mortality was observed in recent decades; MELD score was a significant predictor.

Conclusions:

  • Short-term mortality in severe alcohol-associated hepatitis remains unacceptably high.
  • There has been no significant improvement in sAH short-term mortality over the past decades.
  • Urgent development of effective therapies, improved liver transplant selection, and enhanced prognostic tools are crucial for sAH management.