Jordi Gratacós-Ginès, Pilar Ruz-Zafra, Miriam Celada-Sendino, Aina Martí-Carretero, Clàudia Pujol, Rosa Martín-Mateos, Víctor Echavarría, Luis E Frisancho, Sonia García, Mónica Barreales, Javier Tejedor-Tejada, Sergio Vázquez-Rodríguez, Nuria Cañete, Carlos Fernández-Carrillo, María Valenzuela, David Martí-Aguado, Diana Horta, Marta Quiñones, Vanesa Bernal-Monterde, Silvia Acosta, Tomás Artaza, José Pinazo, Carmen Villar-Lucas, Ana Clemente-Sánchez, Ester Badia-Aranda, Álvaro Giráldez-Gallego, Manuel Rodríguez, Pau Sancho-Bru, Joaquín Cabezas, Meritxell Ventura-Cots, Conrado Fernández-Rodríguez, Victoria Aguilera, Santiago Tomé, Ramon Bataller, Juan Caballería, Elisa Pose
{"title":"Recurrent alcohol-associated hepatitis is common and is associated with increased mortality.","authors":"Jordi Gratacós-Ginès, Pilar Ruz-Zafra, Miriam Celada-Sendino, Aina Martí-Carretero, Clàudia Pujol, Rosa Martín-Mateos, Víctor Echavarría, Luis E Frisancho, Sonia García, Mónica Barreales, Javier Tejedor-Tejada, Sergio Vázquez-Rodríguez, Nuria Cañete, Carlos Fernández-Carrillo, María Valenzuela, David Martí-Aguado, Diana Horta, Marta Quiñones, Vanesa Bernal-Monterde, Silvia Acosta, Tomás Artaza, José Pinazo, Carmen Villar-Lucas, Ana Clemente-Sánchez, Ester Badia-Aranda, Álvaro Giráldez-Gallego, Manuel Rodríguez, Pau Sancho-Bru, Joaquín Cabezas, Meritxell Ventura-Cots, Conrado Fernández-Rodríguez, Victoria Aguilera, Santiago Tomé, Ramon Bataller, Juan Caballería, Elisa Pose","doi":"10.1097/HEP.0000000000000825","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and aims: </strong>Alcohol relapse after surviving an episode of alcohol-associated hepatitis (AH) is common. However, the clinical features, risk factors, and prognostic implications of recurrent alcohol-associated hepatitis (RAH) are not well described.</p><p><strong>Approach and results: </strong>A registry-based study was done of patients admitted to 28 Spanish hospitals for an episode of AH between 2014 and 2021. Baseline demographics and laboratory variables were collected. Risk factors for RAH were investigated using Cox regression analysis. We analyzed the severity of the index episodes of AH and compared it to that of RAH. Long-term survival was assessed by Kaplan-Meier curves and log-rank tests. A total of 1118 patients were included in the analysis, 125 (11%) of whom developed RAH during follow-up (median: 17 [7-36] months). The incidence of RAH in patients resuming alcohol use was 22%. The median time to recurrence was 14 (8-29) months. Patients with RAH had more psychiatric comorbidities. Risk factors for developing RAH included age <50 years, alcohol use >10 U/d, and history of liver decompensation. RAH was clinically more severe compared to the first AH (higher MELD, more frequent ACLF, and HE). Moreover, alcohol abstinence during follow-up was less common after RAH (18% vs. 45%, p <0.001). Most importantly, long-term mortality was higher in patients who developed RAH (39% vs. 21%, p = 0.026), and presenting with RAH independently predicted high mortality (HR: 1.55 [1.11-2.18]).</p><p><strong>Conclusions: </strong>RAH is common and has a more aggressive clinical course, including increased mortality. Patients surviving an episode of AH should undergo intense alcohol use disorder therapy to prevent RAH.</p>","PeriodicalId":177,"journal":{"name":"Hepatology","volume":null,"pages":null},"PeriodicalIF":12.9000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hepatology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/HEP.0000000000000825","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/3/5 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background and aims: Alcohol relapse after surviving an episode of alcohol-associated hepatitis (AH) is common. However, the clinical features, risk factors, and prognostic implications of recurrent alcohol-associated hepatitis (RAH) are not well described.
Approach and results: A registry-based study was done of patients admitted to 28 Spanish hospitals for an episode of AH between 2014 and 2021. Baseline demographics and laboratory variables were collected. Risk factors for RAH were investigated using Cox regression analysis. We analyzed the severity of the index episodes of AH and compared it to that of RAH. Long-term survival was assessed by Kaplan-Meier curves and log-rank tests. A total of 1118 patients were included in the analysis, 125 (11%) of whom developed RAH during follow-up (median: 17 [7-36] months). The incidence of RAH in patients resuming alcohol use was 22%. The median time to recurrence was 14 (8-29) months. Patients with RAH had more psychiatric comorbidities. Risk factors for developing RAH included age <50 years, alcohol use >10 U/d, and history of liver decompensation. RAH was clinically more severe compared to the first AH (higher MELD, more frequent ACLF, and HE). Moreover, alcohol abstinence during follow-up was less common after RAH (18% vs. 45%, p <0.001). Most importantly, long-term mortality was higher in patients who developed RAH (39% vs. 21%, p = 0.026), and presenting with RAH independently predicted high mortality (HR: 1.55 [1.11-2.18]).
Conclusions: RAH is common and has a more aggressive clinical course, including increased mortality. Patients surviving an episode of AH should undergo intense alcohol use disorder therapy to prevent RAH.
期刊介绍:
HEPATOLOGY is recognized as the leading publication in the field of liver disease. It features original, peer-reviewed articles covering various aspects of liver structure, function, and disease. The journal's distinguished Editorial Board carefully selects the best articles each month, focusing on topics including immunology, chronic hepatitis, viral hepatitis, cirrhosis, genetic and metabolic liver diseases, liver cancer, and drug metabolism.