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Determinants of long-term outcome in severe alcoholic hepatitis

The latest issue of the Alimentary Pharmacology & Therapeutics identifies determinants of long-term outcome in severe alcoholic hepatitis.

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Although short-term outcome in ssevere alcoholic hepatitis is well described, its long-term course remains uncharacterised.

Dr Potts and colleagues from the United Kingdom assessed determinants of long-term outcome in severe alcoholic hepatitis.

Data were recorded from a cohort with severe alcoholic hepatitis.

Kaplan–Meier and Cox proportional hazards survival analyses were performed to determine predictors of outcome.

The team identified 109 patients, of which 63% were male, aged about 50 years with median follow-up of 41 months.

The calculated pooled gastric cancer incidence-rate was about 0.3% per person-years
Alimentary Pharmacology & Therapeutics

The researchers found that 86% had cirrhosis, and 65% received corticosteroids and/or pentoxifylline.

Overall mortality was 58%, 97% of deaths being liver-related, and 65% occurring after the index hospitalization.

Estimated 5-year survival was 32%.

Hepatorenal syndrome was the only baseline factor independently associated with mortality, although it predicted short-term, rather than long-term outcome.

The team found that of the 87 patients who survived index hospitalization, 65% experienced recidivism.

Abstinence at last follow-up remained the only independent predictor of survival in multivariate analysis.

The researchers found that 5-year survival was higher in abstainers compared with relapsed and continued drinkers.

However, the survival benefit from abstinence only became statistically significant at 18 months postdischarge.

Dr Potts' team commented, "Estimated 5-year survival after index hospitalization with severe alcoholic hepatitis is 32% 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 severe alcoholic hepatitis are urgently needed."

Aliment Pharmacol & Ther 2013: 38(6) 584–595
16 September 2013

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