Mayo Clinic Proceedings: Innovations, Quality & Outcomes (Jul 2017)

Acute Alcoholic Hepatitis

  • Spencer Lourens, PhD,
  • Dharma B. Sunjaya, MD,
  • Ashwani Singal, MD,
  • Suthat Liangpunsakul, MD, MPH,
  • Puneet Puri, MD,
  • Arun Sanyal, MD,
  • Xiaowei Ren, MS,
  • Gregory J. Gores, MD,
  • Svetlana Radaeva, PhD,
  • Naga Chalasani, MD,
  • David W. Crabb, MD,
  • Barry Katz, PhD,
  • Patrick S. Kamath, MD,
  • Vijay H. Shah, MD,
  • David Crabb, MD,
  • Naga Chalasani, MD,
  • Suthat Liangpunsakul, MD,
  • Barry Katz, PhD,
  • Spencer Lourens, PhD,
  • Andy Borst, BS,
  • Ryan Cook, MPH,
  • Andy Qigui Yu, PhD,
  • David Nelson, PhD,
  • Romil Saxena, MD,
  • Sherrie Cummings, RN,
  • Megan Comerford, BS,
  • Lakye Edwards, BS,
  • Vijay H. Shah, MD,
  • Gregory Gores, MD,
  • Patrick S. Kamath, MD,
  • Vikas Verma, PhD,
  • Sarah Wilder, RN, BSN,
  • Amy Olofson, RN,
  • Amanda Schimek,
  • Arun Sanyal, MD,
  • Puneet Puri, MD,
  • Susan Walker, RN, MSN,
  • Svetlana Radaeva, PhD,
  • Andras Orosz, PhD

Journal volume & issue
Vol. 1, no. 1
pp. 37 – 48

Abstract

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Objective: To examine the natural history of acute alcoholic hepatitis (AH) and identify predictors of mortality for AH using data from a prospective multicenter observational study. Participants and Methods: We analyzed data from 164 patients with AH and 131 heavy-drinking controls with no liver disease. Participants underwent clinical/laboratory assessment at baseline and 6 and 12 months after enrollment. Multivariable analyses were conducted to identify variables associated with mortality and examine the association between coffee drinking and risk of AH. Results: Thirty-six patients with AH died during follow-up, with estimated 30-day, 90-day, 180-day, and 1-year survival of 0.91 (95% CI, 0.87-0.96), 0.85 (95% CI, 0.80-0.91), 0.80 (95% CI, 0.74-0.87), and 0.75 (95% CI, 0.68-0.83), respectively. In the multivariable analysis, higher serum bilirubin level (hazard ratio [HR]=1.059; 95% CI, 1.022-1.089), lower hemoglobin level (HR=1.263; 95% CI, 1.012-1.575), and lower platelet count (HR=1.006; 95% CI, 1.001-1.012) were independently associated with mortality in AH. Compared with controls, fewer patients with AH regularly consumed coffee (20% vs 44%; P<.001), and this association between regular coffee drinking and lower risk of AH persisted after controlling for relevant covariates (odds ratio=0.26; 95% CI, 0.15-0.46). Time-dependent receiver operating characteristic curve analysis revealed that Model for End-Stage Liver Disease; Maddrey Discriminant Function; age, serum bilirubin, international normalized ratio, and serum creatinine; and Child-Pugh scores all provided similar discrimination performance at 30 days (area under the curve=0.73-0.77). Conclusion: Alcoholic hepatitis remains highly fatal, with 1-year mortality of 25%. Regular coffee consumption was associated with lower risk of AH in heavy drinkers.