Alcoholic Hepatitis in a Japanese Hospital: Losing Contact With Some Patients After Delirium Tremens May Lead to Missed Critical Events

IF 3.1 3区医学 Q3 BIOCHEMISTRY & MOLECULAR BIOLOGY

Addiction Biology Pub Date : 2025-06-02 DOI:10.1111/adb.70052

Hisanori Muto, Teiji Kuzuya, Yoshihiko Tachi, Yoshiaki Katano, Naoki Ohmiya, Takashi Kobayashi, Satoshi Yamamoto, Naoto Kawabe, Hijiri Sugiyama, Seiya Hagihara, Misae Matsushita, Yutaro Kajino, Yosuke Nagano, Senju Hashimoto

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Abstract

In Japan, the establishment of diagnostic criteria for acute-on-chronic liver failure (ACLF) in 2022 has increased the focus on alcoholic hepatitis. Most hospitals in Japan lack specialized treatment units or psychiatrists for managing alcohol use disorders, leaving hepatologists to handle various aspects of the disease—a challenging task. This study retrospectively investigated the outcomes of alcoholic hepatitis in a typical Japanese hospital setting, stratified by ACLF diagnosis and other features, with the aim of identifying areas for possible improvement. We conducted a retrospective analysis of 88 patients hospitalized with alcoholic hepatitis, reviewing records for the diagnosis of ACLF or related conditions, development of delirium tremens (DT), risk factors, and patient outcomes. Patients meeting the Japanese criteria for ACLF or related conditions had significantly worse survival outcomes. DT developed in 13 patients, with low platelet counts and elevated γ-glutamyl transpeptidase levels identified as risk factors. Prophylactic oral benzodiazepines were found safe and significantly associated with preventing DT. Onset of DT during hospitalization did not measurably impact survival prognosis, but DT patients showed a tendency to break contact with our hospital and critical events may have been missed. While under hepatologist care, patients typically maintained sobriety, but relapse into alcohol-related health problems frequently occurred after follow-up was discontinued. In Japan, hepatologists may be missing important events with alcoholic hepatitis after follow-up discontinuation, especially in patients with DT. Therefore, integrated and collaborative care, particularly a psychosocial approach providing behavioural support, may reduce risk of relapse and improve patient prognosis.

Trial Registration:

All study protocols were reviewed and approved by the ethics committee at Fujita Health University School of Medicine (approval no. HM23-213)

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日本一家医院的酒精性肝炎：与震颤谵妄后的一些患者失去联系可能导致错过关键事件

在日本，2022年建立的急性慢性肝衰竭（ACLF）诊断标准增加了对酒精性肝炎的关注。日本的大多数医院都缺乏专门的治疗部门或精神科医生来治疗酒精使用障碍，这使得肝病学家不得不处理这种疾病的各个方面——这是一项具有挑战性的任务。本研究回顾性调查了日本一家典型医院的酒精性肝炎的预后，根据ACLF诊断和其他特征进行分层，目的是确定可能改善的领域。我们对88例酒精性肝炎住院患者进行了回顾性分析，回顾了ACLF或相关疾病的诊断记录、震颤谵妄（DT）的发展、危险因素和患者结局。满足日本ACLF标准或相关条件的患者生存结果明显较差。13例患者发生DT，血小板计数低和γ-谷氨酰转肽酶水平升高被确定为危险因素。预防性口服苯二氮卓类药物被发现是安全的，并与预防DT显著相关。住院期间DT发病对生存预后无显著影响，但DT患者有与我院断绝联系的倾向，可能错过了关键事件。在肝病专家的护理下，患者通常保持清醒，但在随访停止后，经常发生与酒精相关的健康问题复发。在日本，肝病学家在随访停止后可能会遗漏酒精性肝炎的重要事件，特别是在DT患者中。因此，综合和协作护理，特别是提供行为支持的社会心理方法，可以降低复发风险并改善患者预后。试验注册 : 综述了所有研究协议,经伦理委员会批准Fujita健康大学医学院(批准号hm23 - 213)

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来源期刊

Addiction Biology 生物-生化与分子生物学

CiteScore

8.10

自引率

2.90%

发文量

118

审稿时长

6-12 weeks

期刊介绍： Addiction Biology is focused on neuroscience contributions and it aims to advance our understanding of the action of drugs of abuse and addictive processes. Papers are accepted in both animal experimentation or clinical research. The content is geared towards behavioral, molecular, genetic, biochemical, neuro-biological and pharmacology aspects of these fields. Addiction Biology includes peer-reviewed original research reports and reviews. Addiction Biology is published on behalf of the Society for the Study of Addiction to Alcohol and other Drugs (SSA). Members of the Society for the Study of Addiction receive the Journal as part of their annual membership subscription.