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Determinants of long‐term outcome in severe alcoholic hepatitis
Author(s) -
Potts J. R.,
Goubet S.,
Heneghan M. A.,
Verma S.
Publication year - 2013
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.12427
Subject(s) - medicine , alcoholic hepatitis , abstinence , proportional hazards model , survival analysis , hepatorenal syndrome , cohort , multivariate analysis , gastroenterology , alcoholic liver disease , cirrhosis , surgery , psychiatry
Summary Background Although short‐term outcome in severe alcoholic hepatitis ( SAH ) is well described, its long‐term course remains uncharacterised. Aim To assess determinants of long‐term outcome in SAH . Methods Data were recorded from a cohort with SAH (admission Discriminant Function ( DF ) ≥32). Kaplan–Meier ( KM ) and Cox proportional hazards survival analyses were performed to determine predictors of outcome. Results One hundred and nine patients were included; 63.3% male, aged 49.6 ± 9.4 years with median follow‐up of 40.7 months (95% CI 37.2–44.3). Median DF was 58, 86.2% had cirrhosis and 65.1% received corticosteroids and/or pentoxifylline. Overall mortality was 57.8%, 96.8% of deaths being liver‐related and 65.1% occurring after the index hospitalisation. Estimated 5‐year survival was 31.8%. Hepatorenal syndrome was the only baseline factor independently associated with mortality ( HR 3.78, 95% CI 1.98–7.19, P < 0.0001), although it predicted short‐term, rather than long‐term outcome (median survival 0.52 months, 95% CI 0.43–0.61). Of the 87 patients (79.8%) who survived index hospitalisation, 65.1% experienced recidivism. Abstinence at last follow‐up remained the only independent predictor of survival in multivariate analysis ( HR 0.370, 95% CI 0.168–0.818, P = 0.014). Five‐year survival was higher in abstainers (75.3%) compared with relapsed and continued drinkers (26.8% and 21.0%, respectively, P = 0.005). However, the survival benefit from abstinence only became statistically significant at 18 months postdischarge ( HR 2.714, 95% CI 0.995–7.404, P = 0.051). Conclusions Estimated 5‐year survival after index hospitalisation with SAH is 31.8% with alcohol relapse occurring in two‐thirds of patients. Abstinence remains the only independent predictor of long‐term survival. Novel strategies to improve abstinence after admission with SAH are urgently needed.