Acute Alcoholic Hepatitis: Natural History and Predictors of Mortality Using a Multicenter Prospective Study.
Acute Alcoholic Hepatitis: Natural History and Predictors of Mortality Using a Multicenter Prospective Study.
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DOI：
10.1016/j.mayocpiqo.2017.04.004
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发表时间：
2017-07
期刊：
影响因子：
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通讯作者：
TREAT Consortium
中科院分区：
文献类型：
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作者：
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;TREAT Consortium
研究急性酒精性肝炎（AH）的自然史，并使用前瞻性多中心观察性研究的数据确定AH死亡率的预测因素。我们分析了164例AH患者和131例无肝病的重度饮酒对照组的数据。参与者在基线和入组后6个月和12个月接受临床/实验室评估。进行多变量分析以确定与死亡率相关的变量，并检查咖啡饮用与AH风险之间的关系。36例AH患者在随访期间死亡，估计30天、90天、180天和1年生存率为0.91（95% CI，0.87-0.96）、0.85（95% CI，0.80-0.91）、0.80（95% CI，0.74-0.87）和0.75（95% CI，0.68-0.83）。在多变量分析中，较高的血清胆红素水平（风险比[HR]=1.059; 95% CI，1.022-1.089）、较低的血红蛋白水平（HR=1.263; 95% CI，1.012-1.575）和较低的血小板计数（HR=1.006; 95% CI，1.001-1.012）与AH患者的死亡率独立相关。与对照组相比，较少的AH患者经常饮用咖啡（20% vs 44%; P<0.001），在控制相关协变量后，经常饮用咖啡与AH风险降低之间的相关性持续存在（比值比=0.26; 95%CI，0.15-0.46）。时间依赖性受试者工作特征曲线分析显示，终末期肝病模型; Madelman判别函数;年龄、血清胆红素、国际标准化比值和血清肌酐;以及Child-Pugh评分在30天时均提供了相似的判别性能（曲线下面积=0.73-0.77）。酒精性肝炎仍然是高度致命的，1年死亡率为25%。经常喝咖啡与重度饮酒者AH的风险降低有关。
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. 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. 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%; P<.001), and this association between regular coffee drinking and lower risk of AH persisted after controlling for relevant covariates (odds ratio=0.26; 95% CI, 0.15-0.46). Time-dependent receiver operating characteristic curve analysis revealed that Model for End-Stage Liver Disease; Maddrey Discriminant Function; age, serum bilirubin, international normalized ratio, and serum creatinine; and Child-Pugh scores all provided similar discrimination performance at 30 days (area under the curve=0.73-0.77). Alcoholic hepatitis remains highly fatal, with 1-year mortality of 25%. Regular coffee consumption was associated with lower risk of AH in heavy drinkers.