Clinical characteristics and outcomes of mild to moderate alcoholic hepatitis

Abstract

Summary Introduction & Aim Much is known about alcoholic hepatitis (AH) that is severe enough to require hospitalisation. The characteristics of individuals with alcoholic hepatitis presenting with mild to moderate severity are not well understood. In this study, we investigated the risk factors, characteristics and outcomes of mild to moderate AH (M‐AH). Methods A total of 255 individuals with AH enrolled into a multicenter, prospective, observational study between 12/2014 and 4/2018 was included. Participants were seen at enrollment, 6 and 12 months. M‐AH was defined as MELD ≤20 at presentation, whereas severe AH as MELD ≥21. Results In total, 100 individuals had M‐AH, whereas 155 had severe AH. Individuals with M‐AH were older (49 vs 44 years, P = 0.01), had lower BMI (27 vs 31 kg/m2, P = 0.0007) and more likely to be male (68% vs 55%, P = 0.046) compared to the severe AH group. A higher proportion in the M‐AH group consumed coffee in the last 5 years compared to the severe AH group (29% vs 18%, P = 0.03), and fewer had PNPLA3 risk allele G (P = 0.019) compared to the severe AH group. Average drinks per drinking day (12.9 vs 10.7, P = 0.13) and total number of drinks in last 30‐day period (331 vs 280, P = 0.14) were not different between two groups. Compared to severe AH, patients with M‐AH had significantly lower mortality at 30 days (2% vs 13.6%), 90 days (3% vs 22.6%) and 12 months (10.4% vs 31.4%) (P < 0.001 for all). Conclusions Individuals with M‐AH were older, less obese, drank coffee more often and carried more favourable PNPLA3 genotype compared to severe AH, despite similar alcohol consumption. M‐AH had substantial mortality with one in ten dying by 12 months.

Distinct histopathological phenotypes of severe alcoholic hepatitis suggest different mechanisms driving liver injury and failure

“…Patients with AH have a wide range of clinical presentation, disease severity, and overall prognosis. In mild cases, patients may improve with conservative management and have a favorable outcome ( 37 ). However, in those with severe presentation, such as SAH, the disease is characterized by high short-term mortality ( 38 ) and early liver transplantation is required ( 39 ).…”

Editorial: The clinical characteristics and outcomes of mild to moderate alcoholic hepatitis: The TREAT study

“…In this issue of GastroHep the study investigators publish their major findings from this study. 2 It was carried out between 12/2014 and 04/2018 and enrolled a total of 255 individuals.…”

“…Compared to severe alcoholic hepatitis, patients with moderate disease had significantly lower mortality at 30 days (2% vs 13.6%), 90 days (3% vs 22.6%) and 12 months (10.4% vs 31.4%) (P < .001 for all). 2 As with any condition with a wide clinical spectrum, the main hurdle is defining the boundaries between moderate disease and severe disease. Admission to hospital as a definition of severe disease seem rather arbitrary, so the authors used the MELD score to arbitrate between moderate and severe disease.…”

“…Surprisingly, average drinks per drinking day (12.9 vs 10.7, P = .13) and total number of drinks in last 30‐day period (331 vs 280, P = .14) were not different between two groups. Compared to severe alcoholic hepatitis, patients with moderate disease had significantly lower mortality at 30 days (2% vs 13.6%), 90 days (3% vs 22.6%) and 12 months (10.4% vs 31.4%) ( P < .001 for all) …”

“…It is thus welcome that we have now a prospective study: the TREAT 001 (NCT 02172898) study. In this issue of GastroHep the study investigators publish their major findings from this study . It was carried out between 12/2014 and 04/2018 and enrolled a total of 255 individuals.…”