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Trajectory of Serum Bilirubin Predicts Spontaneous Recovery in a Real-World Cohort of Patients with Alcoholic Hepatitis

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Richard Parker, Joaquin Cabezas, Jose Altamirano, Juan Pablo Arab, Meritxell Ventura-Cots, Ashish Sinha, Ashwin Dhanda, Marco Arrese, C Anne McCune, Ian A Rowe, Bernd Schnabl, Phillipe Mathurin, Debbie Shawcross, Juan Jg Abraldes, Michael R Lucey, Guadalupe Garcia-Tsao, Elizabeth Verna, Robert S Brown, Francisco Bosques-Padilla, Victor Vargas & 3 more Alexandre Louvet, Andrew P Holt, Ramon Bataller

Original languageEnglish
Pages (from-to)e289-e297
JournalClinical Gastroenterology and Hepatology : the official clinical practice journal of the American Gastroenterological Association
Volume20
Issue number2
Early online date12 Jan 2022
DOIs
E-pub ahead of print12 Jan 2022
PublishedFeb 2022

Bibliographical note

Funding Information: Funding No specific financial support was received for this work. The INTEAM consortium is supported by funding from the National Institute on Alcohol Abuse and Alcoholism (1U01AA021908-01). Juan Pablo Arab and Marco Arrese were supported by the Chilean government through the Fondo Nacional de Desarrollo Científico y Tecnológico (1200227 to JPA and 1191145 to MA) and the Comisión Nacional de Investigación Científica y Tecnológica (AFB170005, CARE Chile UC). Joaquin Cabezas was supported by an AEEH ( Spanish Association for the Study of the Liver ) grant (“Juan Rodés 2015”). Publisher Copyright: © 2022 AGA Institute

King's Authors

Abstract

Background and aims: Alcoholic hepatitis (AH) is a severe condition with poor short-term prognosis. Specific treatment with corticosteroids slightly improves short-term survival but is associated with infection and is not used in many centers. A reliable method to identify patients who will recover spontaneously will minimise the numbers of patients who experience side effects of available treatments. Methods: We analysed the trajectory of serum bilirubin concentration over the course of hospital admissions in patients with AH to predict spontaneous survival and the need for treatment. Results: data from 426 patients were analysed. Based on bilirubin trajectory, patients were categorized into three groups: ‘fast fallers’ (bilirubin <0.8 x admission value at day 7), ‘static’ (bilirubin of >0.9 – <1.2 x admission value) and ‘rapid risers’ (bilirubin of ≥1.2 x admission bilirubin). Fast fallers had significantly better 90-day survival compared to other groups (log rank p < .001), and showed no benefit of corticosteroid therapy (OR for survival at 28 days of treatment, 0.94, 95% CI 0.06 - 8.41). These findings remained even amongst patients with severe disease based on initial DF, GAHS or MELD scores. Conclusions: We present an intuitive method of classifying patients with AH based on the trajectory of bilirubin over the first week of admission. It is complimentary to existing scores that identify candidates for corticosteroid treatment or assess response to treatment. This method identifies a group of patients with AH who recover spontaneously and can avoid corticosteroid therapy.

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