Alcohol-related liver disease phenotype impacts survival after an acute variceal bleeding episode.
Edilmar Alvarado, Romano Sassatelli, Alessandra Dell'Era, Marco Senzolo, Juan G Abraldes, Alexander Zipprich, Meritxell Casas, Helena Masnou, Massimo Primignani, Gilberto Silva-Junior, Manuel Romero-Gómez, Marcel Tantau, Maria A Guardascione, Manuel Hernández-Guerra, Marika Rudler, Rafael Bañares, Javier Martinez, Marie A Robic, Christian Jansen, Jose L Calleja, Frederik Nevens, Jaime Bosch, Meritxell Ventura-Cots, Juan C García-Pagan, Joan Genescà, Elba Llop, Ares Villagrasa, Virginia Hernández-Gea, Ramon Bataller, Álvaro Giráldez, Bogdan Procopet, Lucio Amitrano, Candid Villanueva, Dominique Thabut, Luis Ibañez-Samaniego, Agustin Albillos, Christophe Bureau, Jonel Trebicka, Aleksander Krag, Wim Laleman, J M Palazon, Jose Castellote, Susana Rodrigues, Lise L Gluud, Carlos N Ferreira, Nuria Cañete, Manuel Rodríguez, Arnulf Ferlitsch, Jose L Mundi, Henning Gronbaek
Journal: Liver international : official journal of the International Association for the Study of the Liver
2023;43(7):1548-1557
PMID: 37183551
Abstract
BACKGROUND & AIMS
Alcohol-related hepatitis (AH) encompasses a high mortality. AH might be a concomitant event in patients with acute variceal bleeding (AVB). The current study aimed to assess the prevalence of AH in patients with AVB and to compare the clinical outcomes of AH patients to other alcohol-related liver disease (ALD) phenotypes and viral cirrhosis.
METHODS
Multicentre, observational study including 916 patients with AVB falling under the next categories: AH (n = 99), ALD cirrhosis actively drinking (d-ALD) (n = 285), ALD cirrhosis abstinent from alcohol (a-ALD) (n = 227) and viral cirrhosis (n = 305). We used a Cox proportional hazards model to calculate adjusted hazard ratio (HR) of death adjusted by MELD.
RESULTS
The prevalence of AH was 16% considering only ALD patients. AH patients exhibited more complications. Forty-two days transplant-free survival was worse among AH, but statistical differences were only observed between AH and d-ALD groups (84 vs. 93%; p = 0.005), when adjusted by MELD no differences were observed between AH and the other groups. At one-year, survival of AH patients (72.7%) was similar to the other groups; when adjusted by MELD mortality HR was better in AH compared to a-ALD (0.48; 0.29-0.8, p = 0.004). Finally, active drinkers who remained abstinent presented better survival, independently of having AH.
CONCLUSIONS
Contrary to expected, AH patients with AVB present no worse one-year survival than other patients with different alcohol-related phenotypes or viral cirrhosis. Abstinence influences long-term survival and could explain these counterintuitive results.
© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Address:
Liver Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain.; Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain.; Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, IMDIM, University of Barcelona, Barcelona, Spain.; Center for Liver Diseases, Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.; UCM Digestive Diseases and CIBEREHD, University Hospital Virgen del Rocío, Institute of Biomedicine of Seville (CSIC/HUVR/US), University of Seville.; Regional Institute of Gastroenterology and Hepatology "Octavian Fodor", Hepatology Department and "Iuliu Hatieganu", University of Medicine and Pharmacy, 3rd Medical Clinic, Cluj-Napoca, Romania.; Gastroenterology Unit, Ospedale A Cardarelli, Naples, Italy.; Department of Gastroenterology, Hospital of Santa Creu and Sant Pau, Universitat Autònoma de Barcelona, Hospital Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain.; Sorbonne Université, AP-HP. Sorbonne Université, Hôpital de la Pitié-Salpêtrière, service d'hépato-gastroentérologie, Paris, France.; Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, INSERM UMR_S 938, Centre de recherche Saint-Antoine, Maladies métaboliques, biliaires et fibro-inflammatoire du foie, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France.; Servicio de Medicina de Aparato Digestivo Gregorio Marañón, Hospital General Universitario Gregorio Marañón, liSGM, Madrid, Spain.; Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain.; Department of Hepato-Gastroenterology, Purpan Hospital, CHU Toulouse; INSERM U858, University of Toulouse, Toulouse, France.; Department of Internal Medicine I, University of Bonn, Bonn, Germany.; Liver Unit, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, Spain.; Department of Gastroenterology and Hepatology, University of Leuven, KU Leuven, Leuven, Belgium.; ISABIAL, Hospital General y Universitario de Alicante, Dr. Balmis, Alicante, Spain.; Gastroenterology Department, Hepatology Unit, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, Spain.; Gastroenterology and Hepatology Department, Centro Hospitalar São João, Porto, Portugal.; Gastrounit, Medical Division, University Hospital of Hvidovre, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.; Serviço de Gastroenterologia e Hepatologia, Hospital de Santa Maria-Centro Hospitalar, Lisbon Norte, Portugal.; Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.; Department of Gastroenterology, Hospital Central de Asturias, Oviedo, Spain.; Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.; Department of Gastroenterology, University Hospital San Cecilio, Granada, Spain.; Department of Hepatology and Gastroenterology, Aarhus University Hospital & Clinical Institute, Aarhus University, Aarhus, Denmark.; Gastroenterology Department, University Hospital of the Canary Islands, La Laguna, Spain.; Unit of Gastroenterology and Digestive Endoscopy, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.; Gastroenterology Unit, ASST Fatebenefratelli Sacco, Department of Clinical and Biomedical Sciences, University of the Studies of Milan, Milan, Italy.; Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padua, Italy.; Cirrhosis Care Clinic, Division of Gastroenterology (Liver Unit), CEGIIR, University of Alberta, Edmonton, Canada.; Clinic for Internal Medicine IV, University Hospital Jena, Düsseldorf, Germany.; Liver Unit, Gastroenterology Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, Spain.; Hospital Universitari Germans Trias i Pujol, Universitat Autònoma Barcelona, Badalona, Spain.; Division of Gastroenterology and Hepatology, IRCCS Ca' Granda Maggiore Hospital Foundation, University of Milan, Italy.; Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark.; Visceral Surgery and Medicine, Inselspital, Hospital of Bern University CH, Bern, Switzerland.
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