Long-term outcomes in patients with decompensated alcohol-related liver disease, steatohepatitis and Maddrey's discriminant function &lt;32

Degré, Delphine; Stauber, Rudolf; Englebert, Gaël; Sarocchi, Francesca; Verset, Laurine; Rainer, Florian; Spindelboeck, Walter; Njimi, Hassane; Trépo, Eric; Gustot, Thierry; Lackner, Carolin; Deltenre, Pierre; Moreno, Christophe

doi:10.1016/j.jhep.2019.12.023

Cited by 49 publications

(47 citation statements)

References 27 publications

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“…However, we found no statistically significant difference in 28-day mortality between patients with and without HE (p=0.071). In 90-day and 180-day mortality, it has good prognostic value (p<0.001,p=0.001) and is considered an independent risk factor (HR: 1.416, 95% CI: 1.102,1.818, p=0.007; HR: 1.328, 95% CI: 1.046,1.686, p=0.020), consistent with previous studies [ 21 , 22 ]. Monitoring of lactate levels is important in ICU patients with sepsis [ 23 , 24 ].…”

Section: Discussionsupporting

confidence: 89%

Prognostic Value of Acute-On-Chronic Liver Failure (ACLF) Score in Critically Ill Patients with Cirrhosis and ACLF

et al. 2020

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Background In the intensive care unit (ICU), critically ill patients with cirrhosis and acute-on-chronic liver failure (ACLF) continue to have high mortality rates. The AARC ACLF score is a simple, newly-developed score based on Asian ACLF patients, which performs well in prognosis. The present study attempted to verify the prognostic ability of AARC ACLF in non-Asian critically ill patients with cirrhosis and ACLF. Material/Methods We enrolled 786 patients. Relevant clinical data were collected within 24 h after admission to compare the differences between survivors and non-survivors, and all the patients were followed up for at least 180 days. Results The 28-day, 90-day, and 180-day mortality rates were 28.9% (227/786), 36.4% (286/786), and 40.3% (317/786), respectively. Multivariate Cox regression analysis showed that AARC ACLF score (HR: 1.375, 95% CI: 1.247–1.516, P<0.001) was an independent predictive factor of 28-day mortality, and the AUROC of the predictive ability in 28-day mortality of the AARC ACLF score was 0.754. In addition, the AARC ACLF score was regraded into 3 classes (low risk: AARC ACLF <9, intermediate risk: 9≤ AARC ACLF <12, and high risk: AARC ACLF ≥12). The AARC ACLF score can be used for dynamic assessment by retest at days 4–7. Conclusions The AARC ACLF score has a good predictive value for 28-day, 90-day, and 180-day mortality in non-Asian critically ill patients with cirrhosis and ACLF, which is not inferior to CLIF-C ACLFs Lact and other models. It is easy to use at bedside, and it is dynamic and reliable.

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Section: Discussionsupporting

confidence: 89%

Prognostic Value of Acute-On-Chronic Liver Failure (ACLF) Score in Critically Ill Patients with Cirrhosis and ACLF

et al. 2020

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“…Since the 1960s it has been observed that abstinence from alcohol is also key for preventing death in patients with decompensated ALD [31]. This is supported by recent prospective [32] and retrospective cohort studies [33].…”

Section: Treatmentmentioning

confidence: 85%

Alcohol use disorder and the liver

Buchanan

Sinclair

2020

Addiction

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Alcohol use disorders (AUD) cause a range of physical harms, but the major cause of alcohol-related mortality is alcohol-related liver disease (ALD), in some countries accounting for almost 90% of alcohol-related deaths. The risk of ALD has an exponential relationship with increasing alcohol consumption, but is also associated with genetic factors, other lifestyle factors and social deprivation. ALD includes a spectrum of progressive pathology, from liver steatosis to fibrosis and liver cirrhosis. There are no specific treatments for liver cirrhosis, but abstinence from alcohol is key to limit progression of the disease. Over time, cirrhosis can progress (often silently) to decompensated cirrhosis and hepatocellular carcinoma (HCC). Liver transplantation may be suitable for patients with decompensated liver cirrhosis and may also be used as a curative intervention for HCC, but only for a few selected patients, and complete abstinence is a prerequisite. Patients with AUD are also at risk of developing alcoholic hepatitis, which has a high mortality and limited evidence for effective therapies. There is a strong evidence base for the effectiveness of psychosocial and pharmacological interventions for AUD, but very few of these have been trialled in patients with comorbid ALD. Integrated specialist alcohol and hepatology collaborations are required to develop interventions and pathways for patients with ALD and ongoing AUD.

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“…Studies have shown that patients with DF ≥ 32 and no treatment have a mortality rate of 20-50% over 30 days; depending on practices of supportive care [18,19]. Current American College of Gastroenterology guidelines recommend treating AH patients with corticosteroids who have DF ≥ 32 [16,20]. Limitation of this score includes non-standardization of the PT values, and different upper value of the normal range as a laboratory variation depending on the type of thromboplastin used.…”

Section: Discriminant Function (Df)mentioning

confidence: 99%

Emerging Noninvasive Biomarkers, and Medical Management Strategies for Alcoholic Hepatitis: Present Understanding and Scope

Gala

Vatsalya

2020

Cells

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Alcohol use disorder is associated with a wide array of hepatic pathologies ranging from steatosis to alcoholic-related cirrhosis (AC), alcoholic hepatitis (AH), or hepatocellular carcinoma (HCC). Biomarkers are categorized into two main categories: biomarkers associated with alcohol consumption and biomarkers of alcoholic liver disease (ALD). No ideal biomarker has been identified to quantify the degree of hepatocyte death or severity of AH, even though numerous biomarkers have been associated with AH. This review provides information of some of the novel and latest biomarkers that are being investigated and have shown a substantial association with the degree and severity of liver injury and inflammation. Importantly, they can be measured noninvasively. In this manuscript, we consolidate the present understanding and prospects of these biomarkers; and their application in assessing the severity and progression of the alcoholic liver disease (ALD). We also review current and upcoming management options for AH.

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Long-term outcomes in patients with decompensated alcohol-related liver disease, steatohepatitis and Maddrey's discriminant function <32

Cited by 49 publications

References 27 publications

Prognostic Value of Acute-On-Chronic Liver Failure (ACLF) Score in Critically Ill Patients with Cirrhosis and ACLF

Prognostic Value of Acute-On-Chronic Liver Failure (ACLF) Score in Critically Ill Patients with Cirrhosis and ACLF

Alcohol use disorder and the liver

Emerging Noninvasive Biomarkers, and Medical Management Strategies for Alcoholic Hepatitis: Present Understanding and Scope

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