Moderate alcohol-associated hepatitis: A real-world multicenter study

Background:Severe alcohol-associated hepatitis (sAH) is a well-characterized disease with high short-term mortality. However, there is limited research on those with a "less severe condition" (moderate AH). This study aims to characterize in-depth patients with moderate AH (mAH), including...

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Detalles Bibliográficos
Autores: Idalsoaga, F, Díaz, LA, Dunn, W, Mehta, H, Muñoz, K, Caldentey, V, Arnold, J, Ayares, G, Mortuza, R, Sarin, SK, Maiwall, R, Zhang, W, Qian, S, Simonetto, D, Singal, AK, Elfeki, MA, Ramirez-Cadiz, C, Malhi, G, Ahmed, A, Homsi, H, Abid, Z, Cabezas, J, Echavarría, V, Poca, M, Soriano, G, Cuyas, B, Cots, MV, Higuera-De La Tijera, MF, Ayala-Valverde, M, Perez, D, Gomez, J, Abraldes, JG, Al-Karaghouli, M, Jalal, PK, Ibrahim, MA, García-Tsao, G, Goyes, D, Skladany, L, Havaj, DJ, Sulejova, K, Selcanova, SA, Rincón, D, Chacko, KR, Restrepo, JC, Yaquich, P, Toro, LG, Shah, V, Arrese, M, Kamath, PS, Bataller, R, Arab, JP
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2025
País:España
Institución:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repositorio:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:oai:iibsantpau.fundanetsuite.com:p19540
Acceso en línea:https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=19540
Access Level:acceso abierto
Palabra clave:alcohol
alcohol-associated hepatitis
alcohol-associated liver disease
cirrhosis
end-stage liver disease
outcome prediction
Descripción
Sumario:Background:Severe alcohol-associated hepatitis (sAH) is a well-characterized disease with high short-term mortality. However, there is limited research on those with a "less severe condition" (moderate AH). This study aims to characterize in-depth patients with moderate AH (mAH), including the performance of mortality scoring systems, key prognostic factors, and survival over time. Methods:A multicenter retrospective cohort study (2009-2019) included patients with mAH (MELD score <= 20 at admission). Cox regression and receiver operating characteristic curves with AUC were used for analysis. Results:We included 1845 patients with AH (20 centers, 8 countries) between 2009 and 2019. mAH was defined as a MELD score <= 20 at admission. Twenty-four percent met the criteria for an mAH episode. Patients with mAH tend to be older and have a higher proportion of females, with a median MELD of 17 (15-19), Maddrey discriminant function (mDF) of 33 (22-40), the trajectory of serum bilirubin of 0.83 (0.60-1.21), and neutrophil-to-lymphocyte ratio (NLR) of 5 (2.96-8.60). The primary causes of death in mAH included multiple organ failure (34.1%) and infections (16.6%). The cumulative survival rates at 30, 90, and 180 days were 94.3%, 90.4%, and 88.2%, respectively. In multivariable analysis, age was the only significant predictor of 30-day mortality (HR 1.49, 95% CI: 1.27-1.76, p<0.001). Mortality prediction models showed poor performance, with AUC for MELD (0.671), mDF (0.726), trajectory of serum bilirubin (0.733), and NLR (0.697). Conclusions:Patients with moderate AH exhibited a mortality of 11.8% at 6 months, primarily driven by multiple organ failure and infections. These patients also exhibit a different clinical profile compared to those with sAH. Tailored models and therapeutic strategies are needed to improve long-term outcomes in mAH.

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