Abstracts of the 2023 Annual Meeting of the ALEH
More infoAlcohol-associated hepatitis (AH) corresponds to a severe entity with high short-term mortality; however, few studies have been published in patients with moderate AH. This study aimed to characterize patients with moderate AH in a global study, identifying prognostic factors and survival at 30, 90, and 180 days.
Materials and MethodsMulti-center retrospective cohort study, which included patients with moderate AH (2009-2019). Moderate AH was defined as MELD 20 at presentation. We used competing-risk models with liver transplantation as a competing risk to assess variables associated with mortality.
ResultsWe included 564 patients (24 centers, 12 countries). Median age was 48±11.6 years, 29.2% female, and 46.2.5% Caucasian. 51.7% had cirrhosis, and 1.4% underwent liver transplantation. The MELD score on admission was 17 [6-20]. In the entire cohort, 37.7% used corticosteroids. Survival rates at 30, 90, and 180 days were 93.7% (0.911–0.955), 89.1% (0.860–0.916), and 87% (0.836–0.898), respectively. The most frequent causes of death were multiple organ failure (30.4%) and infections (11.5%). In the univariate analysis, variables associated with mortality were age (sHR 1.035, 95%CI:1.020–1.049; p <0.001), Maddrey's discriminant function (sHR 1.013, 95%CI:1.007–1.020; p<0.001), albumin at admission (sHR 0.837, 95%CI:0.682–1.026; p 0.087), INR (sHR 1.534; 95%CI: 1.070–2.198, p=0.020), renal replacement therapy (RRT) (sHR 7.066; 95%CI:4.381–11.392; p<0.001) and infections during hospitalization (sHR 2.079; 95%CI:1.308–3.306; p=0.002)(Table). However, in the multivariate-adjusted model, only age (sHR 1.042; 95%CI:1.019–1.0656, p<0.001), RRT (sHR 7.796; 95%CI:3.993–15.218, p<0.001) and infections during hospitalization (sHR 1.666; 95%CI:0.999–2.779; p=0.050) were associated with mortality. Of note, corticosteroids did not demonstrate benefit.
ConclusionsPatients with moderate AH have a significant mortality at short-term. Infections are associated with higher mortality and are the most important cause of death in these patients. Better models are necessary to predict mortality in moderate AH adequately.
