Trajectory of serum bilirubin predicts spontaneous recovery in a real-world cohort of patients with alcoholic hepatitis - Université de Lille Accéder directement au contenu
Article Dans Une Revue Clinical Gastroenterology and Hepatology Année : 2021

Trajectory of serum bilirubin predicts spontaneous recovery in a real-world cohort of patients with alcoholic hepatitis

Richard Parker
  • Fonction : Auteur
Joaquin Cabezas
  • Fonction : Auteur
Jose Altamirano
  • Fonction : Auteur
Juan Pablo Arab
  • Fonction : Auteur
Meritxell Ventura-Cots
  • Fonction : Auteur
Ashish Sinha
  • Fonction : Auteur
Ashwin Dhanda
  • Fonction : Auteur
Marco Arrese
  • Fonction : Auteur
C. Anne Mccune
  • Fonction : Auteur
Ian A. Rowe
  • Fonction : Auteur
Bernd Schnabl
  • Fonction : Auteur
Debbie L. Shawcross
  • Fonction : Auteur
Juan G. Abraldes
  • Fonction : Auteur
Michael R. Lucey
  • Fonction : Auteur
Guadalupe Garcia-Tsao
  • Fonction : Auteur
Elizabeth C. Verna
  • Fonction : Auteur
Robert S. Brown
  • Fonction : Auteur
Francisco Bosques-Padilla
  • Fonction : Auteur
Victor Vargas
  • Fonction : Auteur
Andrew P. Holt
  • Fonction : Auteur
Ramon Bataller
  • Fonction : Auteur

Résumé

OBJECTIVE: 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.

Dates et versions

hal-04489522 , version 1 (22-03-2024)

Identifiants

Citer

Richard Parker, Joaquin Cabezas, Jose Altamirano, Juan Pablo Arab, Meritxell Ventura-Cots, et al.. Trajectory of serum bilirubin predicts spontaneous recovery in a real-world cohort of patients with alcoholic hepatitis. Clinical Gastroenterology and Hepatology, 2021, Clinical Gastroenterology and Hepatology, ⟨10.1016/j.cgh.2021.01.042⟩. ⟨hal-04489522⟩

Collections

RIIP UNIV-LILLE
0 Consultations
1 Téléchargements

Altmetric

Partager

Gmail Mastodon Facebook X LinkedIn More