1. Identification of optimal therapeutic window for steroid use in severe alcohol-associated hepatitis: A worldwide study
- Author
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Gustavo Romero, Pierre-Emmanuel Rautou, Saba Abdulsada, Kristina R. Chacko, Roberta Chaves Araújo, Won Kim, Rohit Agrawal, Germán Soriano, Juan Pablo Arab, Inés García-Carrera, Wei Zhang, Juan Pablo Arancibia, Seth Buryska, Andreea Bumbu, Richard D. Parker, Diego Rincón, Pamela Yaquich, Alexandre Louvet, Douglas A. Simonetto, Aldo Torre, Patrick S. Kamath, Tazime Issoufaly, Susana Castro-Sanchez, Felipe Zamarripa, Juan Pablo Roblero, Manuel Mendizabal, Vijay H. Shah, Zohaib Syed Haque, Fernando Bessone, Tej I Mehta, Julio Santiago Marcelo, Ramon Bataller, Carolina A. Ramírez, Tehseen Haider, Muhammad Majeed, Virginia Clark, Veronica Prado, Natalia Baeza, Natalia Bystrianska, Prasun K. Jalal, Rakhi Maiwall, Elizabeth C. Verna, Horia Stefanescu, Michael R. Lucey, Philippe Mathurin, Patricia Guerra Salazar, Berta Cuyàs, Ana Clemente-Sanchez, Maria Laura Garrido, Maria A. Poca, Adelina Horhat, A. Rojo, Luis G. Toro, Luis Antonio Díaz, Juan Carlos Restrepo, Francisco Idalsoaga, Lubomir Skladaný, Dalia Morales-Arraez, Diego Piombino, Guadalupe Garcia-Tsao, Florencia Pollarsky, Juan G. Abraldes, Joseph C. Ahn, Jorge Arnold, María de Fátima Higuera de la Tijera, Edilmar Alvarado-Tapias, Ashwani K. Singal, Eduardo Fuentes-López, Shiv Kumar Sarin, Marcela de Sousa Coelho, Victor Vargas, Robert S. Brown, Winston Dunn, Bashar M. Attar, Joaquín Cabezas, Melisa Dirchwolf, Meritxell Ventura-Cots, Jose A Gonzalez, José Altamirano, Adrián Narvaez, P. Nagaraja Rao, Marco Arrese, Anand V. Kulkarni, and Fernando Cairo
- Subjects
0301 basic medicine ,Adult ,Male ,medicine.medical_specialty ,Alcoholic liver disease ,Cirrhosis ,Time Factors ,Alcohol Drinking ,Alcoholic hepatitis ,alcoholic hepatitis ,Severity of Illness Index ,Hepatitis ,corticosteroids ,Maddrey discriminant function ,Cohort Studies ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Retrospective Studies ,Hepatology ,business.industry ,alcohol ,cirrhosis ,Hazard ratio ,Middle Aged ,medicine.disease ,alcohol-associated liver disease ,MELD ,030104 developmental biology ,Methylprednisolone ,Prednisolone ,030211 gastroenterology & hepatology ,Female ,Steroids ,business ,medicine.drug ,alcoholic liver disease ,steroids - Abstract
Background & Aims: Corticosteroids are the only effective therapy for severe alcohol-associated hepatitis (AH), defined by a model for end-stage liver disease (MELD) score >20. However, there are patients who may be too sick to benefit from therapy. Herein, we aimed to identify the range of MELD scores within which steroids are effective for AH. Methods: We performed a retrospective, international multi-center cohort study across 4 continents, including 3,380 adults with a clinical and/or histological diagnosis of AH. The main outcome was mortality at 30 days. We used a discrete-time survival analysis model, and MELD cut-offs were established using the transform-the-endpoints method. Results: In our cohort, median age was 49 (40-56) years, 76.5% were male, and 79% had underlying cirrhosis. Median MELD at admission was 24 (19-29). Survival was 88% (87-89) at 30 days, 77% (76-78) at 90 days, and 72% (72-74) at 180 days. A total of 1,225 patients received corticosteroids. In an adjusted-survival-model, corticosteroid use decreased 30-day mortality by 41% (hazard ratio [HR] 0.59; 0.47-0.74; p 51. The type of corticosteroids used (prednisone, pred-nisolone, or methylprednisolone) was not associated with sur-vival benefit (p = 0.247). Conclusion: Corticosteroids improve 30-day survival only among patients with severe AH, especially with MELD scores between 25 and 39. Lay summary: Alcohol-associated hepatitis is a condition where the liver is severely inflamed as a result of excess alcohol use. It is associated with high mortality and it is not clear whether the most commonly used treatments (corticosteroids) are effective, particularly in patients with very severe liver disease. In this worldwide study, the use of corticosteroids was associated with increased 30-day, but not 90-or 180-day, survival. The maximal benefit was observed in patients with an MELD score (a marker of severity of liver disease; higher scores signify worse disease) between 25-39. However, this benefit was lost in patients with the most severe liver disease (MELD score higher than 51). (C) 2021 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
- Published
- 2021