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Gene signature‐MELD score and alcohol relapse determine long‐term prognosis of patients with severe alcoholic hepatitis
Author(s) -
Deltenre Pierre,
Trépo Eric,
Fujiwara Naoto,
Goossens Nicolas,
Marot Astrid,
Dubois Margaux,
Spahr Laurent,
Henrion Jean,
Moreno Christophe,
Hoshida Yujin
Publication year - 2020
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.14265
Subject(s) - medicine , alcoholic hepatitis , hazard ratio , gastroenterology , proportional hazards model , liver disease , alcoholic liver disease , confidence interval , surgery , cirrhosis
Background The gene‐signature‐model for end stage liver disease (gs‐MELD) score has been shown to be a strong predictor of 6‐month survival in severe alcoholic hepatitis (AH). Currently, only a few studies have evaluated the long‐term prognosis of patients with severe AH. Aim To assess the prognostic value of the gs‐MELD score at 5 years in patients with severe AH. Methods Forty‐eight consecutive patients with AH (25 males, median age 52 years [95% IC: 48‐56]) were included. Results The median gs‐MELD score was 2.6 (95% CI: 2.2‐3.0). According to the gs‐MELD score, 22 patients (46%) were considered to have a poor prognosis. During a median follow‐up of 29 months (95% CI: 4‐43), 19 patients (40%) were abstinent and 24 patients (50%) died. At 5 years, rates of survival were 61% (95% CI: 41‐81) and 26% (95% CI: 11‐55) in patients with low and high gs‐MELD scores ( P = .001), and 81% (95% CI: 58‐96) and 22% (95% CI: 10‐47) in abstainers and in consumers ( P < .001) respectively. In multivariable competing risk regression modelling, gs‐MELD score (subdistribution hazard ratio: 5.78, 95% CI: 2.17‐15.38, P < .001) and recurrent alcohol consumption (subdistribution hazard ratio: 12.18, 95% CI: 3.16‐46.95, P < .001) were independently associated with 5‐year mortality. Conclusions Both gs‐MELD score and alcohol consumption drive AH long‐term prognosis. The gs‐MELD score may guide the development of molecularly targeted therapies in AH.