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Lourens S, Sunjaya DB, Singal A, et al. Acute Alcoholic Hepatitis: Natural History and Predictors of Mortality Using a Multicenter Prospective Study. Mayo Clin Proc Innov Qual Outcomes. 2017;1(1):37-48doi: 10.1016/j.mayocpiqo.2017.04.004.
Lourens, S., Sunjaya, D. B., Singal, A., Liangpunsakul, S., Puri, P., Sanyal, A., Ren, X., Gores, G. J., Radaeva, S., Chalasani, N., Crabb, D. W., Katz, B., Kamath, P. S., Shah, V. H. (2017). Acute Alcoholic Hepatitis: Natural History and Predictors of Mortality Using a Multicenter Prospective Study. Mayo Clinic proceedings. Innovations, quality & outcomes, 1(1), 37-48. https://doi.org/10.1016/j.mayocpiqo.2017.04.004
Lourens, Spencer, et al. "Acute Alcoholic Hepatitis: Natural History and Predictors of Mortality Using a Multicenter Prospective Study." Mayo Clinic proceedings. Innovations, quality & outcomes vol. 1,1 (2017): 37-48. doi: https://doi.org/10.1016/j.mayocpiqo.2017.04.004
Lourens S, Sunjaya DB, Singal A, Liangpunsakul S, Puri P, Sanyal A, Ren X, Gores GJ, Radaeva S, Chalasani N, Crabb DW, Katz B, Kamath PS, Shah VH. Acute Alcoholic Hepatitis: Natural History and Predictors of Mortality Using a Multicenter Prospective Study. Mayo Clin Proc Innov Qual Outcomes. 2017 Apr 28;1(1):37-48. doi: 10.1016/j.mayocpiqo.2017.04.004. eCollection 2017 Jul. PMID: 30225400; PMCID: PMC6134907.
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Mayo Clin Proc Innov Qual Outcomes. 2017 Apr 28;1(1):37-48. doi: 10.1016/j.mayocpiqo.2017.04.004. eCollection 2017 Jul.

Acute Alcoholic Hepatitis: Natural History and Predictors of Mortality Using a Multicenter Prospective Study.

Mayo Clinic proceedings. Innovations, quality & outcomes

Spencer Lourens, Dharma B Sunjaya, Ashwani Singal, Suthat Liangpunsakul, Puneet Puri, Arun Sanyal, Xiaowei Ren, Gregory J Gores, Svetlana Radaeva, Naga Chalasani, David W Crabb, Barry Katz, Patrick S Kamath, Vijay H Shah,

Affiliations

  1. Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN.
  2. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
  3. Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL.
  4. Roudebush Veterans Administration Medical Center, Indianapolis, IN.
  5. Division of Gastroenterology and Hepatology, Department of Medicine, Virginia Commonwealth University, Richmond.
  6. Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN.
  7. National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD.
  8. Eskenazi Health Hospital, Indianapolis, IN.

PMID: 30225400 PMCID: PMC6134907 DOI: 10.1016/j.mayocpiqo.2017.04.004

Abstract

OBJECTIVE: To examine the natural history of acute alcoholic hepatitis (AH) and identify predictors of mortality for AH using data from a prospective multicenter observational study.

PARTICIPANTS AND METHODS: We analyzed data from 164 patients with AH and 131 heavy-drinking controls with no liver disease. Participants underwent clinical/laboratory assessment at baseline and 6 and 12 months after enrollment. Multivariable analyses were conducted to identify variables associated with mortality and examine the association between coffee drinking and risk of AH.

RESULTS: Thirty-six patients with AH died during follow-up, with estimated 30-day, 90-day, 180-day, and 1-year survival of 0.91 (95% CI, 0.87-0.96), 0.85 (95% CI, 0.80-0.91), 0.80 (95% CI, 0.74-0.87), and 0.75 (95% CI, 0.68-0.83), respectively. In the multivariable analysis, higher serum bilirubin level (hazard ratio [HR]=1.059; 95% CI, 1.022-1.089), lower hemoglobin level (HR=1.263; 95% CI, 1.012-1.575), and lower platelet count (HR=1.006; 95% CI, 1.001-1.012) were independently associated with mortality in AH. Compared with controls, fewer patients with AH regularly consumed coffee (20% vs 44%;

CONCLUSION: Alcoholic hepatitis remains highly fatal, with 1-year mortality of 25%. Regular coffee consumption was associated with lower risk of AH in heavy drinkers.

Keywords: ABIC, age, serum bilirubin, international normalized ratio, and serum creatinine; AH, alcoholic hepatitis; AIC, Akaike Information Criterion; ALT, alanine aminotransferase; AST, aspartate aminotransferase; AUC, area under the curve; BMI, body mass index; CP, Child-Pugh; HR, hazard ratio; INR, international normalized ratio; IQR, interquartile range; MELD, Model for End-Stage Liver Disease; NA, not applicable; OR, odds ratio; ROC, receiver operating characteristic; STOPAH, Steroids or Pentoxifylline for Alcoholic Hepatitis; TREAT, Translational Research and Evolving Alcoholic Hepatitis Treatment; WBC, white blood cell; mDF, Maddrey Discriminant Function

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