Alcoholic Liver Disease

Fairbanks, Kyrsten D.

doi:10.1016/b978-1-4160-6643-9.00075-8

Cited by 5 publications

(9 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One hypothesis that has been proposed to explain higher mortality rates in patients with more severe disease is a ceiling effect of drug therapy in preventing the inflammatory cascade and ultimate liver damage. 2,5 Mendenhall and colleagues first described this phenomenon after observing that steroid treatment increased mortality in patients with an MDF > 54. 5 This cutoff should be further studied to determine if a true MDF range of treatment benefit exists before reaching a treatment ceiling.…”

Section: Discussionmentioning

confidence: 99%

“…1 ALD encompasses AH that occurs as a result of prolonged alcohol consumption and ranges in severity from asymptomatic to liver failure. 2 AH is associated with a high mortality burden, up to 15% at 30 days, which is dependent on disease severity at presentation. 1 Per American Association for the Study of Liver Diseases (AASLD) guidelines, disease severity should be initially established upon presentation in all AH patients to aid in therapeutic management.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Pharmacologic Treatment of Alcoholic Hepatitis: Examining Outcomes Based on Disease Severity Stratification

Owens

Snyder

Twilla

2016

Journal of Clinical and Experimental Hepatology

View full text Add to dashboard Cite

Objectives: Maddrey discriminant function (MDF) score is a measure of disease prognosis in alcoholic hepatitis (AH) used to identify patients at highest risk of mortality and determine the need for initiation of pharmacologic treatment. The purpose of this study was to evaluate the effects of pharmacologic therapy for hospitalized AH patients as stratified by MDF score. Methods: A retrospective review of patients with an AH diagnosis admitted to a Methodist LeBonheur Healthcare adult hospital between 06/2009 and 06/2014 was conducted. Patients !18 years of age with an ICD-9 code for AH were evaluated. Results: Of the 493 patients screened, 234 met the inclusion criteria, comprised of 62 patients with an MDF ! 32 (treatment, n = 42 vs. no treatment, n = 20) and 172 patients with an MDF < 32 (treatment, n = 15 vs. no treatment, n = 157). For the patients with an MDF ! 32, there was no statistically significant difference between the treatment group vs. non-treatment group regarding 28-day mortality (31% vs. 11%, respectively; P = 0.18) and 6-month mortality (45% treatment vs. 38% non-treatment; P = 0.75). For the patients with an MDF <32, there was no statistically significant difference between the treatment group vs. non-treatment group regarding 28-day mortality (0% vs. 7%, respectively; P > 0.99) and 6-month mortality (11% treatment vs. 13% non-treatment; P > 0.99). There was no difference in incidence of acute kidney injury, hepatorenal syndrome, development of infection or hepatic encephalopathy between the treatment vs. non-treatment groups. Conclusions: Pharmacologic treatment showed no survival benefit, regardless of disease severity. Given the mortality risk seen in mild-moderate AH patients not receiving treatment and concern for a possible treatment ceiling effect in severe AH patients, more data are needed to adequately assess the utility of MDF in selecting appropriate candidates for AH treatment. ( J CLIN EXP HEPATOL 2016;6:275-281)

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Pharmacologic Treatment of Alcoholic Hepatitis: Examining Outcomes Based on Disease Severity Stratification

Owens

Snyder

Twilla

2016

Journal of Clinical and Experimental Hepatology

View full text Add to dashboard Cite

show abstract

“…The cytochrome P450 system is also intimately involved in the metabolism of alcohol; more specifically the cytochrome P450 2E1 (CYP2E1) isoenzyme is involved (21). About 10% of ethanol oxidation occurs in the microsomal cytochrome P450 CYP2E1.…”

Section: Cytochrome P450 2e1 Pathwaymentioning

confidence: 99%

“…Both, alcohol dehydrogenase and acetaldehyde dehydrogenase, cause a reduction of NAD + to NADH (21). This leads to an increase in the NADH/NAD + ratio in the hepatocyte, which promotes lipogenesis and decreases gluconeogenesis and fatty acid oxidation (21). Increased lipogenesis in hepatocytes leads to fat accumulation (steatosis) throughout hepatocytes and liver parenchyma.…”

Section: A Increase In the Nadh/nad + Ratiomentioning

confidence: 99%

“…However, some exam findings are more commonly seen in liver disease caused by alcohol, such as parotid enlargement, Dupuytren's contracture, and feminization in males (31). AH has considerable overlap with other liver disease etiologies and they share common nonspecific symptoms, such as: anorexia, weight loss, abdominal pain, abdominal distention, fatigue, nausea, and vomiting (21). More advanced liver disease, or decompensated AH, may present with symptoms, such as jaundice, ascites, spider angiomas, fever, and encephalopathy (21).…”

Section: Physical Findingmentioning

confidence: 99%

See 1 more Smart Citation