Alcohol abstinence in patients surviving an episode of alcoholic hepatitis: Prediction and impact on long‐term survival

Altamirano, José; López‐Pelayo, Hugo; Michelena, Javier; Jones, Patricia D.; Ortega, Lluïsa; Ginès, Pere; Caballería, Juan; Gual, Antoni; Bataller, Ramón; Lligoña, Anna

doi:10.1002/hep.29338

Cited by 131 publications

(120 citation statements)

References 43 publications

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“…On the one hand, the conclusions of this study, and a similar recent prospective account of survivors of severe AH by Louvet et al might, appear prosaic . It is standard practice to urge patients who survive an episode of severe AH to abstain from alcohol.…”

supporting

confidence: 67%

“…For medical caregivers, the events that follow the discharge of those patients who survive are often obscure and given little attention until the next admission. In this issue of Hepatology , Altamirano and colleagues provide a fascinating account of the sequel to an admission in 162 patients with well‐characterized AH, 142 of whom survived to be discharged . Their study is retrospective, but the process of data collection and focus on drinking history mean that it yields several valuable insights.…”

mentioning

confidence: 99%

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Redefining Successful Treatment of Severe Alcoholic Hepatitis

Lucey

2017

Hepatology

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supporting

confidence: 67%

mentioning

confidence: 99%

Redefining Successful Treatment of Severe Alcoholic Hepatitis

Lucey

2017

Hepatology

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“…Two studies have already identified alcohol consumption as the main driver of long‐term prognosis in AH patients. In these studies, the other factor associated with outcome was the Lille score in one study, and the MELD score in the other . The present study has the advantage over these 2 studies of using the gs‐MELD score, which has shown better predictive value than either the Lille score or the MELD score alone for short‐term prognosis assessment, as highlighted in the last American Association for the Study of the Liver guidelines .…”

Section: Discussionmentioning

confidence: 66%

“…As alcoholic liver disease has a deep impact on public health and on the liver transplantation waiting list, accurate prediction of both short‐ and long‐term prognosis of patients with severe AH is mandatory for guiding therapeutic strategy . However, only a few studies have evaluated the long‐term prognosis of patients with severe AH . The aim of the present study was to assess the long‐term prognostic value of the gs‐MELD score among patients with severe AH.…”

Section: Introductionmentioning

confidence: 99%

Gene signature‐MELD score and alcohol relapse determine long‐term prognosis of patients with severe alcoholic hepatitis

Deltenre

Trépo

Fujiwara

et al. 2019

Liver International

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Background The gene‐signature‐model for end stage liver disease (gs‐MELD) score has been shown to be a strong predictor of 6‐month survival in severe alcoholic hepatitis (AH). Currently, only a few studies have evaluated the long‐term prognosis of patients with severe AH. Aim To assess the prognostic value of the gs‐MELD score at 5 years in patients with severe AH. Methods Forty‐eight consecutive patients with AH (25 males, median age 52 years [95% IC: 48‐56]) were included. Results The median gs‐MELD score was 2.6 (95% CI: 2.2‐3.0). According to the gs‐MELD score, 22 patients (46%) were considered to have a poor prognosis. During a median follow‐up of 29 months (95% CI: 4‐43), 19 patients (40%) were abstinent and 24 patients (50%) died. At 5 years, rates of survival were 61% (95% CI: 41‐81) and 26% (95% CI: 11‐55) in patients with low and high gs‐MELD scores (P = .001), and 81% (95% CI: 58‐96) and 22% (95% CI: 10‐47) in abstainers and in consumers (P < .001) respectively. In multivariable competing risk regression modelling, gs‐MELD score (subdistribution hazard ratio: 5.78, 95% CI: 2.17‐15.38, P < .001) and recurrent alcohol consumption (subdistribution hazard ratio: 12.18, 95% CI: 3.16‐46.95, P < .001) were independently associated with 5‐year mortality. Conclusions Both gs‐MELD score and alcohol consumption drive AH long‐term prognosis. The gs‐MELD score may guide the development of molecularly targeted therapies in AH.

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“…AR was defined as the intake of any alcoholic drink after LT. This variable was further categorized as follows: No AR. Heavy AR, which was defined as binge drinking (the consumption of 5 or more SDUs [male] or 4 or more SDUs [female] on a single occasion) or more than 4 drinking days per week Nonheavy AR, which was defined as patients who drink after LT (including slips) and did not fulfill the definition of heavy AR. …”

Section: Methodsmentioning

confidence: 99%

Prediction of Alcohol Relapse Among Liver Transplant Candidates With Less Than 6 Months of Abstinence Using the High‐Risk Alcoholism Relapse Score

et al. 2019

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The selection of liver transplantation (LT) candidates with alcohol‐use disorder (AUD) is influenced by the risk of alcohol relapse (AR) after LT. We aimed to investigate the risk factors of AR after LT and its impact on graft and recipient outcomes. A retrospective study was conducted that included all consecutive patients with AUD undergoing LT from January 2004 to April 2016 (n = 309), excluding patients with alcoholic hepatitis. Odds ratios (ORs) and 95% confidence intervals (CIs) for AR were analyzed by multinomial logistic regression. Cox regression with time‐dependent covariates was used to analyze patient survival and graft cirrhosis. There were 70 (23%) patients who presented AR (median follow‐up, 68 months), most of them (n = 44, 63%) presenting heavy AR. The probability of heavy AR was 2.3%, 7.5%, 12%, and 29% at 1, 3, 5, and 10 years after LT, respectively. The independent risk factors for heavy AR included a High‐Risk Alcoholism Relapse (HRAR) score ≥3 (OR, 2.39; 95% CI, 1.02‐5.56; P = 0.04) and the duration of abstinence (months) before LT (OR, 0.81; 95% CI, 0.66‐0.98; P = 0.03). In recipients with <6 months of abstinence before LT, the probability of heavy AR after LT was higher in patients with an HRAR score ≥3 than in those with an HRAR score <3 (20%, 36.7%, and 47% versus 6.8%, 12.4%, and 27% at 1, 3, and 5 years, respectively; log‐rank 0.013). The risk of graft cirrhosis was increased in patients with heavy AR (hazard ratio, 3.44; 95% CI, 1.58‐7.57; P = 0.002) compared with nonrelapsers, with no differences in patient survival. In conclusion, the HRAR score is helpful in identifying the risk of harmful AR after LT in candidates with <6 months of alcohol abstinence without alcoholic hepatitis. These patients could benefit from a longterm integrative patient‐centered approach after LT until lifestyle changes are implemented.

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Alcohol abstinence in patients surviving an episode of alcoholic hepatitis: Prediction and impact on long‐term survival

Cited by 131 publications

References 43 publications

Redefining Successful Treatment of Severe Alcoholic Hepatitis

Redefining Successful Treatment of Severe Alcoholic Hepatitis

Gene signature‐MELD score and alcohol relapse determine long‐term prognosis of patients with severe alcoholic hepatitis

Prediction of Alcohol Relapse Among Liver Transplant Candidates With Less Than 6 Months of Abstinence Using the High‐Risk Alcoholism Relapse Score

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