Francisco Idalsoaga, Luis Antonio Diaz, Winston Dunn, Heer Mehta, Vicente Caldentey, Jorge Arnold, Gustavo Ayares, Shiv K Sarin, Rakhi Maiwall, Wei Zhang, Steve Qian, Douglas Simonetto, Ashwani K Singal, Mohamed A Elfeki, Mohammad Qasim Khan, Rokhsana Mortuza, Gurpreet Malhi, Alvi Husni Islam, Leonardo Guizzetti, Carolina Ramirez-Cadiz, Joaquín Cabezas, Victor Echavarria, Maria Poca, Berta Cuyas, German Soriano, Meritxell Ventura Cots, María Fátima Higuera-De La Tijera, Juan G Abraldes, Mustafa Al-Karaghouli, Lubomir Skladaný, Daniel Jan Havaj, Diego Rincón, Vijay Shah, Marco Arrese, Patrick S Kamath, Ramon Bataller, Juan Pablo Arab
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Pentoxifylline, an anti-tumour necrosis factor-alpha agent, has been proposed for its potential to improve outcomes, especially in patients with acute kidney injury (AKI). We aimed to evaluate the impact of pentoxifylline on mortality in patients with sAH and AKI in a well-characterised global cohort.</p><p><strong>Methods: </strong>We conducted a retrospective, registry-based study including patients meeting the National Institute on Alcohol Abuse and Alcoholism clinical criteria for sAH and AKI. Mortality was the primary endpoint, with liver transplantation as a competing risk. Statistical analysis included Cox regression and Kaplan-Meier survival estimates.</p><p><strong>Results: </strong>We included 525 patients from 20 centres across eight countries. The median age was 48 years, with 26.1% females, and 76.9% had a history of cirrhosis. Multivariable Cox regression models showed that pentoxifylline use was not associated with survival (HR 1.20, 95% CI 0.85 to 1.69, p=0.291). Factors associated with mortality included age (HR 1.23, 95% CI 1.10 to 1.36, p<0.001), Model for End-Stage Liver Disease score at admission (HR 1.06, 95% CI 1.04 to 1.08, p<0.001) and renal replacement therapy use (HR 1.39, 95% CI 1.05 to 1.84, p=0.019). The main causes of death were multiple organ failure (42%), infections (10%), oesophageal varices bleeding (7%) and renal failure (6%).</p><p><strong>Conclusion: </strong>Pentoxifylline showed no significant benefit on mortality in patients with sAH and AKI. 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引用次数: 0
摘要
背景:严重酒精相关性肝炎(sAH)是一种危及生命且死亡率高的疾病,其中使用皮质类固醇是唯一显示出短期益处的治疗方法。己酮可可碱是一种抗肿瘤坏死因子- α的药物,因其改善预后的潜力而被提出,特别是对急性肾损伤(AKI)患者。我们的目的是评估己酮茶碱对sAH和AKI患者死亡率的影响。方法:我们进行了一项基于登记的回顾性研究,纳入了符合国家酒精滥用和酒精中毒研究所sAH和AKI临床标准的患者。死亡率是主要终点,肝移植是一个竞争风险。统计分析包括Cox回归和Kaplan-Meier生存估计。结果:我们纳入了来自8个国家20个中心的525名患者。中位年龄为48岁,女性占26.1%,76.9%有肝硬化史。多变量Cox回归模型显示,己酮茶碱的使用与生存率无关(HR 1.20, 95% CI 0.85 ~ 1.69, p=0.291)。与死亡率相关的因素包括年龄(HR 1.23, 95% CI 1.10至1.36)。结论:己酮茶碱对sAH和AKI患者的死亡率没有显著的益处。需要进一步的研究来完善这一高危人群的治疗策略。
Pentoxifylline use in alcohol-associated hepatitis with acute kidney injury does not improve survival: a global study.
Background: Severe alcohol-associated hepatitis (sAH) is a life-threatening condition with high mortality, where corticosteroid use is the only treatment that has shown short-term benefits. Pentoxifylline, an anti-tumour necrosis factor-alpha agent, has been proposed for its potential to improve outcomes, especially in patients with acute kidney injury (AKI). We aimed to evaluate the impact of pentoxifylline on mortality in patients with sAH and AKI in a well-characterised global cohort.
Methods: We conducted a retrospective, registry-based study including patients meeting the National Institute on Alcohol Abuse and Alcoholism clinical criteria for sAH and AKI. Mortality was the primary endpoint, with liver transplantation as a competing risk. Statistical analysis included Cox regression and Kaplan-Meier survival estimates.
Results: We included 525 patients from 20 centres across eight countries. The median age was 48 years, with 26.1% females, and 76.9% had a history of cirrhosis. Multivariable Cox regression models showed that pentoxifylline use was not associated with survival (HR 1.20, 95% CI 0.85 to 1.69, p=0.291). Factors associated with mortality included age (HR 1.23, 95% CI 1.10 to 1.36, p<0.001), Model for End-Stage Liver Disease score at admission (HR 1.06, 95% CI 1.04 to 1.08, p<0.001) and renal replacement therapy use (HR 1.39, 95% CI 1.05 to 1.84, p=0.019). The main causes of death were multiple organ failure (42%), infections (10%), oesophageal varices bleeding (7%) and renal failure (6%).
Conclusion: Pentoxifylline showed no significant benefit on mortality in patients with sAH and AKI. Further studies are needed to refine treatment strategies for this high-risk group.