Zapalenie wątroby alkoholowe – Rokowania, prognozy i postęp choroby

Zapalenie wątroby alkoholowe
Rokowania, prognozy i postęp choroby

Zapalenie wątroby alkoholowe cechuje się wysoką śmiertelnością krótkoterminową, szczególnie w ciężkich przypadkach, definiowanych jako wskaźnik Maddreya (MDF) ≥ 32, gdzie śmiertelność 30-dniowa wynosi 30-50%, a 6-miesięczna około 40%. Kluczowe dla oceny rokowania są modele prognostyczne takie jak MDF, MELD (ciężkie zapalenie przy MELD ≥ 21), Glasgow Alcoholic Hepatitis Score (GAHS > 8), oraz wynik Lille, który pozwala ocenić odpowiedź na terapię kortykosteroidami (przerwanie leczenia przy Lille ≥ 0,45 po 7 dniach). Dodatkowo, biomarkery takie jak czynnik von Willebranda (VWF-CBA ≥ 750 IU/dL) i K18M65 (≤ 2629,4 IU/L wskazuje na lepsze rokowanie) dostarczają istotnych informacji prognostycznych, szczególnie w ciężkich postaciach choroby. Obecność żółtaczki, encefalopatii wątrobowej, marskości oraz zaburzeń krzepnięcia (czas protrombinowy wydłużony > 5 sekund) pogarszają rokowanie.

Prognostyczne markery w zapaleniu wątroby alkoholowym

Tradycyjne systemy oceny prognostycznej
Nowe markery prognostyczne
Histologiczne markery prognostyczne

Kluczowe czynniki prognostyczne w zapaleniu wątroby alkoholowym
Rokowanie krótko- i długoterminowe

Rokowanie krótkoterminowe
Rokowanie długoterminowe

Implikacje terapeutyczne dla rokowania
Czynniki prognostyczne dla określonych grup pacjentów

Zapalenie wątroby alkoholowe o mniejszym nasileniu
Ciężkie zapalenie wątroby alkoholowe

Abstynencja a rokowanie
Podsumowanie czynników prognostycznych

Kolejne rozdziały

Prognostyczne markery w zapaleniu wątroby alkoholowym

Zapalenie wątroby alkoholowe charakteryzuje się wysoką śmiertelnością krótkoterminową, zwłaszcza w ciężkich przypadkach. ¹ Dokładna ocena prognostyczna ma kluczowe znaczenie w podejmowaniu decyzji terapeutycznych i określeniu dalszego postępowania. Pacjenci z ciężką postacią choroby (zdefiniowaną jako wskaźnik Maddreya (MDF) > 32) mają 30-50% śmiertelność w ciągu 30 dni. Około 40% pacjentów z ciężkim zapaleniem wątroby alkoholowej umiera w ciągu 6 miesięcy od wystąpienia objawów klinicznych. ² Obecność żółtaczki i encefalopatii wątrobowej w momencie zgłoszenia się do lekarza wskazuje na gorsze rokowanie. ³

Tradycyjne systemy oceny prognostycznej

Do oceny rokowania u pacjentów z zapaleniem wątroby alkoholowym stosuje się kilka sprawdzonych modeli prognostycznych:

Funkcja Dyskryminacyjna Maddreya (MDF) – jest jednym z najczęściej używanych narzędzi do oceny ciężkości choroby. Ciężkie zapalenie wątroby alkoholowej definiuje się jako wynik MDF ≥ 32. ⁴ Pacjenci z MDF ≥ 32 przy przyjęciu mają przeżywalność 71% i 62% odpowiednio po 28 i 84 dniach. ⁵

Model Końcowego Stadium Choroby Wątroby (MELD) – również powszechnie stosowany do określenia ciężkości choroby. Ciężkie zapalenie wątroby alkoholowe definiuje się jako wynik MELD ≥ 21. ⁶ Badania wykazały, że wynik MELD w pierwszym dniu hospitalizacji może być równie dokładny jak inne wskaźniki w przewidywaniu przeżywalności wewnątrzszpitalnej. ⁷

Glasgow Alcoholic Hepatitis Score (GAHS) – to system punktowy opracowany na podstawie pięciu zmiennych niezależnie związanych z wynikiem: wiek, stężenie bilirubiny w surowicy (w 1. i 6-9. dniu), stężenie mocznika we krwi, czas protrombinowy oraz liczba białych krwinek we krwi obwodowej. ⁸ Zauważalny wzrost śmiertelności występuje przy punktacji powyżej 8, a krzywa ROC sugeruje, że używanie wyniku > 8 do definiowania złego rokowania jest optymalne dla jednoczesnej maksymalizacji czułości i swoistości. ⁹

Wynik Lille – służy do rozróżnienia pacjentów, którzy prawdopodobnie zareagują na steroidy, od tych, którzy nie odpowiedzą na takie leczenie. Przewiduje, którzy pacjenci mogą mieć gorsze wyniki, jeśli terapia steroidowa będzie kontynuowana dłużej niż siedem dni. ¹⁰ Stosowanie kortykosteroidów należy przerwać u pacjentów, którzy nie wykazują początkowej odpowiedzi (tj. wynik Lille ≥ 0,45 w 7. dniu). ¹¹

Nowe markery prognostyczne

Czynnik von Willebranda (VWF) – ostatnie badania wykazały, że poziom czynnika von Willebranda w osoczu jest znacznie podwyższony u pacjentów z ciężkim zapaleniem wątroby alkoholowej i koreluje z niewydolnością narządów. ¹² Podwyższony wyjściowy poziom VWF-CBA (≥750 IU/dL) miał dodatkową rolę w przewidywaniu przeżywalności wewnątrzszpitalnej. ¹³ Jest to obiecujący biomarker, który nie jest uwzględniony w obecnie stosowanych systemach punktowych. ¹⁴

Marker K18M65 – kryteria prognostyczne z Louisville wykorzystują biomarker aktywności dla trwającej śmierci komórek wątroby, K18M65, do przewidywania 90-dniowej śmiertelności u pacjentów z ciężkim zapaleniem wątroby alkoholowej. ¹⁵ Korzystną prognozę wskazuje poziom K18M65 ≤ 2629,4 IU/L. ¹⁶

Histologiczne markery prognostyczne

Alkoholowy Histologiczny Wynik Zapalenia Wątroby (AHHS) – jest to stosunkowo nowy model kliniczny do przewidywania krótkoterminowej śmiertelności u pacjentów z zapaleniem wątroby alkoholowym. Badania w koreańskiej kohorcie pacjentów wykazały, że zmodyfikowany AHHS był znacząco związany z przeżyciem całkowitym. ¹⁷ W szczególności typ zastoju żółci i nasilenie zwłóknienia były istotnie związane z długoterminowym przeżyciem powyżej 6 miesięcy. ¹⁸ Wyniki te sugerują, że AHHS może być użytecznym narzędziem do przewidywania długoterminowego rokowania raczej niż krótkoterminowej śmiertelności u pacjentów z mniej ciężkim zapaleniem wątroby alkoholowej. ¹⁹

Kluczowe czynniki prognostyczne w zapaleniu wątroby alkoholowym

Przy określaniu rokowania w zapaleniu wątroby alkoholowym należy uwzględnić następujące czynniki:

Histologicznie potwierdzone zapalenie wątroby alkoholowej – precyzyjne rozpoznanie potwierdzone badaniem histopatologicznym²⁰
Stężenie bilirubiny w surowicy > 2,5 mg/dl – podwyższony poziom bilirubiny jest wskaźnikiem pogorszonej funkcji wątroby²¹
Stężenie albuminy w surowicy < 2,5 g/dl – obniżony poziom albuminy wskazuje na upośledzoną zdolność syntetyczną wątroby²²
Czas protrombinowy wydłużony o > 5 sekund – zaburzenia krzepnięcia świadczące o poważnym uszkodzeniu wątroby²³
Obecność żółtaczki i encefalopatii wątrobowej przy prezentacji klinicznej – wskazuje na gorsze rokowanie²⁴
Obecność marskości wątroby jako choroby podstawowej – negatywnie wpływa na długoterminowe rokowanie²⁵
Kontynuacja spożywania alkoholu po diagnozie – istotnie pogarsza rokowanie²⁶

Rokowanie krótko- i długoterminowe

Rokowanie krótkoterminowe

Wskaźniki śmiertelności w zapaleniu wątroby alkoholowym są wysokie, zwłaszcza w ciężkich przypadkach. Ogólna przeżywalność wynosi 77% i 68% odpowiednio po 28 i 84 dniach. ²⁷ 28-dniowa śmiertelność w ciężkim zapaleniu wątroby alkoholowej wynosi od 16% do 30%, a roczna śmiertelność sięga 56%. ²⁸

Pacjenci z ciężkim zapaleniem wątroby alkoholowej (MDF > 32) mają 30-50% śmiertelność w ciągu 30 dni. ²⁹ Około 40% pacjentów z ciężkim zapaleniem wątroby alkoholowej umiera w ciągu 6 miesięcy od wystąpienia zespołu klinicznego. ³⁰

Rokowanie długoterminowe

Łagodne zapalenie wątroby alkoholowej generalnie ma łagodny przebieg i jest całkowicie odwracalne po zaprzestaniu spożywania alkoholu. ³¹ Osoby, które przestają pić alkohol po diagnozie, wykazują znaczną poprawę po 6-12 miesiącach. Łagodniejsze przypadki często ustępują całkowicie. Cięższe przypadki mogą wykazywać stopniową poprawę w kolejnych latach. ³²

Jeśli pacjent nie przestanie pić po diagnozie, ma zmniejszoną przewidywaną długość życia. Dla mężczyzn, którzy nie przestają pić, wskaźnik pięcioletniego przeżycia wynosi około 70%. Dla kobiet, które nie przestają pić, wynosi on 30%. ³³

Osoby z ciężkim zapaleniem wątroby alkoholowej i zaawansowaną chorobą wątroby mają gorsze rokowanie. Do 40% osób z ciężkim zapaleniem wątroby alkoholowej umiera w ciągu sześciu miesięcy od diagnozy. ³⁴

Implikacje terapeutyczne dla rokowania

Identyfikacja pacjentów z wysokim ryzykiem niekorzystnego wyniku ma kluczowe znaczenie dla podjęcia odpowiednich decyzji terapeutycznych:

Odpowiedź na kortykosteroidy – wynik Lille po 7 dniach leczenia pomaga określić, którzy pacjenci skorzystają z kontynuacji terapii steroidowej. Jeśli wynik Lille sugeruje odpowiedź, dawkę kortykosteroidów należy kontynuować przez łącznie 28 dni, a następnie stopniowo zmniejszać. ³⁵
Wczesny przeszczep wątroby – istnieje rosnące poparcie dla wczesnego przeszczepu wątroby u niektórych pacjentów z ciężkim zapaleniem wątroby alkoholowej, zamiast wymagania sześciu miesięcy abstynencji od alkoholu i udziału w poradnictwie dotyczącym zaprzestania picia alkoholu. ³⁶
Leczenie zaburzeń związanych z alkoholem – trwałe leczenie zaburzeń związanych z używaniem alkoholu ma zasadnicze znaczenie dla długoterminowego przeżycia pacjentów z zapaleniem wątroby alkoholowej. ³⁷

Czynniki prognostyczne dla określonych grup pacjentów

Zapalenie wątroby alkoholowe o mniejszym nasileniu

W przypadku pacjentów z mniej ciężkim zapaleniem wątroby alkoholowej, histologiczny wynik zapalenia wątroby alkoholowego (AHHS) może być bardziej wartościowy w przewidywaniu długoterminowego rokowania niż krótkoterminowej śmiertelności. ³⁸ Typ zastoju żółci i nasilenie zwłóknienia mają szczególne znaczenie dla przeżycia długoterminowego powyżej 6 miesięcy. ³⁹

Ciężkie zapalenie wątroby alkoholowe

Pacjenci z ciężkim zapaleniem wątroby alkoholowej wymagają bardziej intensywnego monitorowania i mogą być kandydatami do wczesnego przeszczepu wątroby. Nowe biomarkery, takie jak czynnik von Willebranda i K18M65, mogą pomóc w identyfikacji pacjentów o najwyższym ryzyku śmiertelności wewnątrzszpitalnej. ⁴⁰⁴¹

Abstynencja a rokowanie

Zaprzestanie spożywania alkoholu jest najważniejszym czynnikiem prognostycznym w zapaleniu wątroby alkoholowej. Jeśli choroba nie jest zbyt zaawansowana, może być odwracalna po zaprzestaniu spożywania alkoholu. Ci, którzy nie przestają pić, będą nadal postępować w kierunku marskości wątroby i niewydolności wątroby. ⁴²

Pacjenci, którzy przestają pić alkohol po diagnozie, wykazują znaczną poprawę już po 6-12 miesiącach. Łagodniejsze przypadki często całkowicie ustępują, podczas gdy cięższe przypadki mogą wykazywać stopniową poprawę w kolejnych latach. ⁴³

Osoby z ciężkim zapaleniem wątroby alkoholowej i zaawansowaną chorobą wątroby mają gorsze rokowanie nawet przy abstynencji, a do 40% osób z ciężkim zapaleniem wątroby alkoholowej umiera w ciągu sześciu miesięcy od diagnozy. ⁴⁴

Podsumowanie czynników prognostycznych

Dokładna ocena rokowania w zapaleniu wątroby alkoholowym jest kluczowa dla odpowiedniego postępowania terapeutycznego. Tradycyjne skale, takie jak MDF, MELD i GAHS, pozostają podstawą oceny ciężkości choroby i przewidywania wyników. ⁴⁵⁴⁶ Nowe biomarkery, w tym czynnik von Willebranda i K18M65, oferują dodatkowe możliwości stratyfikacji ryzyka. ⁴⁷⁴⁸

Zaprzestanie spożywania alkoholu pozostaje najważniejszym czynnikiem wpływającym na długoterminowe przeżycie, a ciągłe leczenie zaburzeń związanych z używaniem alkoholu jest niezbędne dla długoterminowego przeżycia pacjentów. ⁴⁹⁵⁰

Kolejne rozdziały

Zapraszamy do dalszego czytania naszego leksykonu.

Wybierz kolejny rozdział z menu poniżej, aby otworzyć nową podstronę kompedium wiedzy i uzyskać szczegółowe informację o leku, substancji lub chorobie.

Materiały źródłowe

#1 Analysis of factors predictive of mortality in alcoholic hepatitis and derivation and validation of the Glasgow alcoholic hepatitis score
https://pmc.ncbi.nlm.nih.gov/articles/PMC1774903/
Alcoholic hepatitis is associated with a high short term mortality. […] Using variables associated with mortality we have derived and validated an accurate scoring system to assess outcome in alcoholic hepatitis. […] This score was able to identify patients at greatest risk of death throughout their admission. […] The GAHS was derived from five variables independently associated with outcome: age (p=0.001) and, from day 1 results, serum bilirubin (p0.001), blood urea (p=0.019) and, from day 69 results, serum bilirubin (p0.001), prothrombin time (p=0.002), and peripheral blood white blood cell count (p=0.001). […] Overall survival was 77% and 68% at days 28 and 84, respectively. […] Patients with an admission mDF of 32 had a survival of 71% and 62% at days 28 and 84, respectively.
#2 Alcoholic-Associated Hepatitis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK470217/
Patients with severe alcoholic hepatitis with an MDF greater than 32 have 30-day mortality of 30% to 50%. […] Forty percent of the patients with severe alcoholic hepatitis die within 6 months after the onset of the clinical syndrome. Jaundice and hepatic encephalopathy at the time of presentation indicate a poorer outcome. […] To determine prognosis the following factors need to be considered: Histologically proven alcohol hepatitis, Serum bilirubin greater than 2.5 mg/dl, Serum albumin less than 2.5 g/dl, Prothrombin time more than 5 seconds. […] Mild alcoholic hepatitis generally runs a benign course and is completely reversible with the cessation of alcohol consumption.
#3 Alcoholic-Associated Hepatitis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK470217/
Patients with severe alcoholic hepatitis with an MDF greater than 32 have 30-day mortality of 30% to 50%. […] Forty percent of the patients with severe alcoholic hepatitis die within 6 months after the onset of the clinical syndrome. Jaundice and hepatic encephalopathy at the time of presentation indicate a poorer outcome. […] To determine prognosis the following factors need to be considered: Histologically proven alcohol hepatitis, Serum bilirubin greater than 2.5 mg/dl, Serum albumin less than 2.5 g/dl, Prothrombin time more than 5 seconds. […] Mild alcoholic hepatitis generally runs a benign course and is completely reversible with the cessation of alcohol consumption.
#4 Alcoholic Hepatitis: Diagnosis and Management | AAFP
https://www.aafp.org/pubs/afp/issues/2022/0400/p412.html
Laboratory-based prognostic scores, including Maddrey Discriminant Function and the Model for End-Stage Liver Disease, help determine disease severity and treatment options. […] Overall and in-hospital mortality are high for severe alcoholic hepatitis, with a 28-day mortality rate of 16% to 30% and a one-year mortality rate of 56%. […] The presence of underlying cirrhosis and continued alcohol use negatively impact long-term prognosis. […] After establishing the diagnosis of alcoholic hepatitis, clinicians should use validated laboratory-based prognostic tools to determine severity, prognosis, and treatment options. […] Severe alcoholic hepatitis is defined as a score of at least 32 using the Maddrey Discriminant Function tool or at least 21 using the Model for End-Stage Liver Disease tool.
#5 Analysis of factors predictive of mortality in alcoholic hepatitis and derivation and validation of the Glasgow alcoholic hepatitis score
https://pmc.ncbi.nlm.nih.gov/articles/PMC1774903/
Alcoholic hepatitis is associated with a high short term mortality. […] Using variables associated with mortality we have derived and validated an accurate scoring system to assess outcome in alcoholic hepatitis. […] This score was able to identify patients at greatest risk of death throughout their admission. […] The GAHS was derived from five variables independently associated with outcome: age (p=0.001) and, from day 1 results, serum bilirubin (p0.001), blood urea (p=0.019) and, from day 69 results, serum bilirubin (p0.001), prothrombin time (p=0.002), and peripheral blood white blood cell count (p=0.001). […] Overall survival was 77% and 68% at days 28 and 84, respectively. […] Patients with an admission mDF of 32 had a survival of 71% and 62% at days 28 and 84, respectively.
#6 Alcoholic Hepatitis: Diagnosis and Management | AAFP
https://www.aafp.org/pubs/afp/issues/2022/0400/p412.html
Laboratory-based prognostic scores, including Maddrey Discriminant Function and the Model for End-Stage Liver Disease, help determine disease severity and treatment options. […] Overall and in-hospital mortality are high for severe alcoholic hepatitis, with a 28-day mortality rate of 16% to 30% and a one-year mortality rate of 56%. […] The presence of underlying cirrhosis and continued alcohol use negatively impact long-term prognosis. […] After establishing the diagnosis of alcoholic hepatitis, clinicians should use validated laboratory-based prognostic tools to determine severity, prognosis, and treatment options. […] Severe alcoholic hepatitis is defined as a score of at least 32 using the Maddrey Discriminant Function tool or at least 21 using the Model for End-Stage Liver Disease tool.
#7
https://journals.lww.com/cmii/fulltext/2020/18030/von_willebrand_factor__a_biomarker_to_predict.4.aspx
On day 1 of hospital stay, plasma VWF-CBA level was as accurate as the MELD score to predict in-hospital survival in the 34 severe alcoholic hepatitis patients. […] In this exploratory study, we demonstrate plasma VWF as a useful static predictor of short-term survival in patients with severe alcoholic hepatitis and also very severe alcoholic hepatitis.
#8 Analysis of factors predictive of mortality in alcoholic hepatitis and derivation and validation of the Glasgow alcoholic hepatitis score
https://pmc.ncbi.nlm.nih.gov/articles/PMC1774903/
Alcoholic hepatitis is associated with a high short term mortality. […] Using variables associated with mortality we have derived and validated an accurate scoring system to assess outcome in alcoholic hepatitis. […] This score was able to identify patients at greatest risk of death throughout their admission. […] The GAHS was derived from five variables independently associated with outcome: age (p=0.001) and, from day 1 results, serum bilirubin (p0.001), blood urea (p=0.019) and, from day 69 results, serum bilirubin (p0.001), prothrombin time (p=0.002), and peripheral blood white blood cell count (p=0.001). […] Overall survival was 77% and 68% at days 28 and 84, respectively. […] Patients with an admission mDF of 32 had a survival of 71% and 62% at days 28 and 84, respectively.
#9 Analysis of factors predictive of mortality in alcoholic hepatitis and derivation and validation of the Glasgow alcoholic hepatitis score
https://pmc.ncbi.nlm.nih.gov/articles/PMC1774903/
The GAHS was calculated as the sum of the scores derived. […] There was a marked rise in mortality when a score greater than 8 was attained, and a receiver operating curve suggests that using scores greater than 8 to define poor prognosis is optimum for simultaneous maximisation of sensitivity and specificity. […] In conclusion, we have identified factors related to mortality in patients presenting with clinical alcoholic hepatitis. Using these factors we have created a scoring system for patients which is simple to calculate and has a high degree of accuracy in predicting mortality. This score has been validated in a second data set.
#10 Alcoholic Hepatitis: Diagnosis and Management | AAFP
https://www.aafp.org/pubs/afp/issues/2022/0400/p412.html
The Lille score distinguishes patients who would likely be responsive vs. unresponsive to steroids, predicting who could have poorer outcomes if steroid therapy was continued beyond seven days. […] Corticosteroid use should be discontinued in patients who do not show an initial response (i.e., Lille score of 0.45 or more on day 7). […] If the Lille score suggests responsiveness, the corticosteroid dose should be continued for a total of 28 days and then tapered. […] There is growing support for early liver transplantation in some patients with severe alcoholic hepatitis, rather than requiring six months of alcohol abstinence and engagement in alcohol cessation counseling. […] Ongoing treatment of alcohol use disorder is paramount to long-term survival of patients with alcoholic hepatitis.
#11 Alcoholic Hepatitis: Diagnosis and Management | AAFP
https://www.aafp.org/pubs/afp/issues/2022/0400/p412.html
The Lille score distinguishes patients who would likely be responsive vs. unresponsive to steroids, predicting who could have poorer outcomes if steroid therapy was continued beyond seven days. […] Corticosteroid use should be discontinued in patients who do not show an initial response (i.e., Lille score of 0.45 or more on day 7). […] If the Lille score suggests responsiveness, the corticosteroid dose should be continued for a total of 28 days and then tapered. […] There is growing support for early liver transplantation in some patients with severe alcoholic hepatitis, rather than requiring six months of alcohol abstinence and engagement in alcohol cessation counseling. […] Ongoing treatment of alcohol use disorder is paramount to long-term survival of patients with alcoholic hepatitis.
#12
https://journals.lww.com/cmii/fulltext/2020/18030/von_willebrand_factor__a_biomarker_to_predict.4.aspx
The aim of this study is to assess the utility of plasma von-Willebrand factor (VWF) levels in predicting in-hospital survival for patients with severe alcoholic hepatitis. […] Plasma VWF levels are markedly elevated, correlate with organ failure, and predict in-hospital survival in severe alcoholic hepatitis, and also in very severe alcoholic hepatitis, patients. […] The key finding of this study is the identification of a new biomarker to predict prognosis in severe alcoholic hepatitis patients. This new biomarker (plasma VWF) is not included in the currently used scoring systems to stratify disease severity and predict survival in severe alcoholic hepatitis patients. […] Elevated baseline plasma VWF-CBA (750 IU/dL) and fulfillment of criteria for very severe alcoholic hepatitis had an additive role in the prediction of in-hospital survival in patients with severe alcoholic hepatitis.
#13
https://journals.lww.com/cmii/fulltext/2020/18030/von_willebrand_factor__a_biomarker_to_predict.4.aspx
The aim of this study is to assess the utility of plasma von-Willebrand factor (VWF) levels in predicting in-hospital survival for patients with severe alcoholic hepatitis. […] Plasma VWF levels are markedly elevated, correlate with organ failure, and predict in-hospital survival in severe alcoholic hepatitis, and also in very severe alcoholic hepatitis, patients. […] The key finding of this study is the identification of a new biomarker to predict prognosis in severe alcoholic hepatitis patients. This new biomarker (plasma VWF) is not included in the currently used scoring systems to stratify disease severity and predict survival in severe alcoholic hepatitis patients. […] Elevated baseline plasma VWF-CBA (750 IU/dL) and fulfillment of criteria for very severe alcoholic hepatitis had an additive role in the prediction of in-hospital survival in patients with severe alcoholic hepatitis.
#14
https://journals.lww.com/cmii/fulltext/2020/18030/von_willebrand_factor__a_biomarker_to_predict.4.aspx
The aim of this study is to assess the utility of plasma von-Willebrand factor (VWF) levels in predicting in-hospital survival for patients with severe alcoholic hepatitis. […] Plasma VWF levels are markedly elevated, correlate with organ failure, and predict in-hospital survival in severe alcoholic hepatitis, and also in very severe alcoholic hepatitis, patients. […] The key finding of this study is the identification of a new biomarker to predict prognosis in severe alcoholic hepatitis patients. This new biomarker (plasma VWF) is not included in the currently used scoring systems to stratify disease severity and predict survival in severe alcoholic hepatitis patients. […] Elevated baseline plasma VWF-CBA (750 IU/dL) and fulfillment of criteria for very severe alcoholic hepatitis had an additive role in the prediction of in-hospital survival in patients with severe alcoholic hepatitis.
#15 Louisville Prognosis Criteria for Alcohol-Associated Hepatitis Severity â School of Medicine University of Louisville
https://louisville.edu/medicine/departments/medicine/divisions/gimedicine/LOUPAHS
This algorithm predicts the survival rate of the severe alcohol-associated hepatitis patients for 90-day mortality based on the biomarker activity for the ongoing liver cell death marker, K18M65. […] This criteria can be used for assessing the 90-day mortality among the alcohol-associated liver disease patients, who have reached the stage of severe alcoholic hepatitis. […] Recommendation for medical management strategies in severe alcohol-associated hepatitis patients. […] The algorithm is specific for severe Alcohol-Associated Hepatitis designed for survivability. […] Survival landmark: Favorable Indication of Prognosis – K18M652629.4 IU/L.
#16 Louisville Prognosis Criteria for Alcohol-Associated Hepatitis Severity â School of Medicine University of Louisville
https://louisville.edu/medicine/departments/medicine/divisions/gimedicine/LOUPAHS
This algorithm predicts the survival rate of the severe alcohol-associated hepatitis patients for 90-day mortality based on the biomarker activity for the ongoing liver cell death marker, K18M65. […] This criteria can be used for assessing the 90-day mortality among the alcohol-associated liver disease patients, who have reached the stage of severe alcoholic hepatitis. […] Recommendation for medical management strategies in severe alcohol-associated hepatitis patients. […] The algorithm is specific for severe Alcohol-Associated Hepatitis designed for survivability. […] Survival landmark: Favorable Indication of Prognosis – K18M652629.4 IU/L.
#17 Prognostic Value of the Alcoholic Hepatitis Histologic Score in Korean Patients with Biopsy-Proven Alcoholic Hepatitis
https://www.gutnliver.org/journal/view.html?volume=14&number=5&spage=636
The alcoholic hepatitis histologic score (AHHS) is a recently developed clinical model for predicting short-term mortality in Caucasian patients with alcoholic hepatitis (AH). The AHHS has not been extensively validated in other ethnic populations. This study validated the AHHS in a Korean patient cohort. […] None of the individual AHHS components were associated with 3-month mortality. However, the bilirubinostasis type and fibrosis severity were significantly associated with AH mortality beyond 6 months. […] In this prospective Korean AH cohort, the modified AHHS was significantly associated with overall survival (OS). Therefore, the AHHS might be a useful histological prognosticator for long-term prognosis in patients with nonsevere AH. […] The type of bilirubinostasis and severity of fibrosis were significantly associated with long-term survival greater than 6 months. The bilirubinostasis pattern and fibrosis stage were also significantly associated with OS. The AHHS was significantly associated with OS when a cutoff of 5 points was used. Therefore, these results suggest that long-term survival (as compared to short-term survival) may be predicted by the AHHS in patients with nonsevere AH. […] Our results suggest that the AHHS is a useful tool to predict long-term prognosis rather than short-term mortality in Korean patients with relatively nonsevere AH.
#18 Prognostic Value of the Alcoholic Hepatitis Histologic Score in Korean Patients with Biopsy-Proven Alcoholic Hepatitis
https://www.gutnliver.org/journal/view.html?volume=14&number=5&spage=636
The alcoholic hepatitis histologic score (AHHS) is a recently developed clinical model for predicting short-term mortality in Caucasian patients with alcoholic hepatitis (AH). The AHHS has not been extensively validated in other ethnic populations. This study validated the AHHS in a Korean patient cohort. […] None of the individual AHHS components were associated with 3-month mortality. However, the bilirubinostasis type and fibrosis severity were significantly associated with AH mortality beyond 6 months. […] In this prospective Korean AH cohort, the modified AHHS was significantly associated with overall survival (OS). Therefore, the AHHS might be a useful histological prognosticator for long-term prognosis in patients with nonsevere AH. […] The type of bilirubinostasis and severity of fibrosis were significantly associated with long-term survival greater than 6 months. The bilirubinostasis pattern and fibrosis stage were also significantly associated with OS. The AHHS was significantly associated with OS when a cutoff of 5 points was used. Therefore, these results suggest that long-term survival (as compared to short-term survival) may be predicted by the AHHS in patients with nonsevere AH. […] Our results suggest that the AHHS is a useful tool to predict long-term prognosis rather than short-term mortality in Korean patients with relatively nonsevere AH.
#19 Prognostic Value of the Alcoholic Hepatitis Histologic Score in Korean Patients with Biopsy-Proven Alcoholic Hepatitis
https://www.gutnliver.org/journal/view.html?volume=14&number=5&spage=636
The alcoholic hepatitis histologic score (AHHS) is a recently developed clinical model for predicting short-term mortality in Caucasian patients with alcoholic hepatitis (AH). The AHHS has not been extensively validated in other ethnic populations. This study validated the AHHS in a Korean patient cohort. […] None of the individual AHHS components were associated with 3-month mortality. However, the bilirubinostasis type and fibrosis severity were significantly associated with AH mortality beyond 6 months. […] In this prospective Korean AH cohort, the modified AHHS was significantly associated with overall survival (OS). Therefore, the AHHS might be a useful histological prognosticator for long-term prognosis in patients with nonsevere AH. […] The type of bilirubinostasis and severity of fibrosis were significantly associated with long-term survival greater than 6 months. The bilirubinostasis pattern and fibrosis stage were also significantly associated with OS. The AHHS was significantly associated with OS when a cutoff of 5 points was used. Therefore, these results suggest that long-term survival (as compared to short-term survival) may be predicted by the AHHS in patients with nonsevere AH. […] Our results suggest that the AHHS is a useful tool to predict long-term prognosis rather than short-term mortality in Korean patients with relatively nonsevere AH.
#20 Alcoholic-Associated Hepatitis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK470217/
Patients with severe alcoholic hepatitis with an MDF greater than 32 have 30-day mortality of 30% to 50%. […] Forty percent of the patients with severe alcoholic hepatitis die within 6 months after the onset of the clinical syndrome. Jaundice and hepatic encephalopathy at the time of presentation indicate a poorer outcome. […] To determine prognosis the following factors need to be considered: Histologically proven alcohol hepatitis, Serum bilirubin greater than 2.5 mg/dl, Serum albumin less than 2.5 g/dl, Prothrombin time more than 5 seconds. […] Mild alcoholic hepatitis generally runs a benign course and is completely reversible with the cessation of alcohol consumption.
#21 Alcoholic-Associated Hepatitis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK470217/
Patients with severe alcoholic hepatitis with an MDF greater than 32 have 30-day mortality of 30% to 50%. […] Forty percent of the patients with severe alcoholic hepatitis die within 6 months after the onset of the clinical syndrome. Jaundice and hepatic encephalopathy at the time of presentation indicate a poorer outcome. […] To determine prognosis the following factors need to be considered: Histologically proven alcohol hepatitis, Serum bilirubin greater than 2.5 mg/dl, Serum albumin less than 2.5 g/dl, Prothrombin time more than 5 seconds. […] Mild alcoholic hepatitis generally runs a benign course and is completely reversible with the cessation of alcohol consumption.
#22 Alcoholic-Associated Hepatitis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK470217/
Patients with severe alcoholic hepatitis with an MDF greater than 32 have 30-day mortality of 30% to 50%. […] Forty percent of the patients with severe alcoholic hepatitis die within 6 months after the onset of the clinical syndrome. Jaundice and hepatic encephalopathy at the time of presentation indicate a poorer outcome. […] To determine prognosis the following factors need to be considered: Histologically proven alcohol hepatitis, Serum bilirubin greater than 2.5 mg/dl, Serum albumin less than 2.5 g/dl, Prothrombin time more than 5 seconds. […] Mild alcoholic hepatitis generally runs a benign course and is completely reversible with the cessation of alcohol consumption.
#23 Alcoholic-Associated Hepatitis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK470217/
Patients with severe alcoholic hepatitis with an MDF greater than 32 have 30-day mortality of 30% to 50%. […] Forty percent of the patients with severe alcoholic hepatitis die within 6 months after the onset of the clinical syndrome. Jaundice and hepatic encephalopathy at the time of presentation indicate a poorer outcome. […] To determine prognosis the following factors need to be considered: Histologically proven alcohol hepatitis, Serum bilirubin greater than 2.5 mg/dl, Serum albumin less than 2.5 g/dl, Prothrombin time more than 5 seconds. […] Mild alcoholic hepatitis generally runs a benign course and is completely reversible with the cessation of alcohol consumption.
#24 Alcoholic-Associated Hepatitis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK470217/
Patients with severe alcoholic hepatitis with an MDF greater than 32 have 30-day mortality of 30% to 50%. […] Forty percent of the patients with severe alcoholic hepatitis die within 6 months after the onset of the clinical syndrome. Jaundice and hepatic encephalopathy at the time of presentation indicate a poorer outcome. […] To determine prognosis the following factors need to be considered: Histologically proven alcohol hepatitis, Serum bilirubin greater than 2.5 mg/dl, Serum albumin less than 2.5 g/dl, Prothrombin time more than 5 seconds. […] Mild alcoholic hepatitis generally runs a benign course and is completely reversible with the cessation of alcohol consumption.
#25 Alcoholic Hepatitis: Diagnosis and Management | AAFP
https://www.aafp.org/pubs/afp/issues/2022/0400/p412.html
Laboratory-based prognostic scores, including Maddrey Discriminant Function and the Model for End-Stage Liver Disease, help determine disease severity and treatment options. […] Overall and in-hospital mortality are high for severe alcoholic hepatitis, with a 28-day mortality rate of 16% to 30% and a one-year mortality rate of 56%. […] The presence of underlying cirrhosis and continued alcohol use negatively impact long-term prognosis. […] After establishing the diagnosis of alcoholic hepatitis, clinicians should use validated laboratory-based prognostic tools to determine severity, prognosis, and treatment options. […] Severe alcoholic hepatitis is defined as a score of at least 32 using the Maddrey Discriminant Function tool or at least 21 using the Model for End-Stage Liver Disease tool.
#26 Alcoholic Hepatitis: Diagnosis and Management | AAFP
https://www.aafp.org/pubs/afp/issues/2022/0400/p412.html
Laboratory-based prognostic scores, including Maddrey Discriminant Function and the Model for End-Stage Liver Disease, help determine disease severity and treatment options. […] Overall and in-hospital mortality are high for severe alcoholic hepatitis, with a 28-day mortality rate of 16% to 30% and a one-year mortality rate of 56%. […] The presence of underlying cirrhosis and continued alcohol use negatively impact long-term prognosis. […] After establishing the diagnosis of alcoholic hepatitis, clinicians should use validated laboratory-based prognostic tools to determine severity, prognosis, and treatment options. […] Severe alcoholic hepatitis is defined as a score of at least 32 using the Maddrey Discriminant Function tool or at least 21 using the Model for End-Stage Liver Disease tool.
#27 Analysis of factors predictive of mortality in alcoholic hepatitis and derivation and validation of the Glasgow alcoholic hepatitis score
https://pmc.ncbi.nlm.nih.gov/articles/PMC1774903/
Alcoholic hepatitis is associated with a high short term mortality. […] Using variables associated with mortality we have derived and validated an accurate scoring system to assess outcome in alcoholic hepatitis. […] This score was able to identify patients at greatest risk of death throughout their admission. […] The GAHS was derived from five variables independently associated with outcome: age (p=0.001) and, from day 1 results, serum bilirubin (p0.001), blood urea (p=0.019) and, from day 69 results, serum bilirubin (p0.001), prothrombin time (p=0.002), and peripheral blood white blood cell count (p=0.001). […] Overall survival was 77% and 68% at days 28 and 84, respectively. […] Patients with an admission mDF of 32 had a survival of 71% and 62% at days 28 and 84, respectively.
#28 Alcoholic Hepatitis: Diagnosis and Management | AAFP
https://www.aafp.org/pubs/afp/issues/2022/0400/p412.html
Laboratory-based prognostic scores, including Maddrey Discriminant Function and the Model for End-Stage Liver Disease, help determine disease severity and treatment options. […] Overall and in-hospital mortality are high for severe alcoholic hepatitis, with a 28-day mortality rate of 16% to 30% and a one-year mortality rate of 56%. […] The presence of underlying cirrhosis and continued alcohol use negatively impact long-term prognosis. […] After establishing the diagnosis of alcoholic hepatitis, clinicians should use validated laboratory-based prognostic tools to determine severity, prognosis, and treatment options. […] Severe alcoholic hepatitis is defined as a score of at least 32 using the Maddrey Discriminant Function tool or at least 21 using the Model for End-Stage Liver Disease tool.
#29 Alcoholic-Associated Hepatitis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK470217/
Patients with severe alcoholic hepatitis with an MDF greater than 32 have 30-day mortality of 30% to 50%. […] Forty percent of the patients with severe alcoholic hepatitis die within 6 months after the onset of the clinical syndrome. Jaundice and hepatic encephalopathy at the time of presentation indicate a poorer outcome. […] To determine prognosis the following factors need to be considered: Histologically proven alcohol hepatitis, Serum bilirubin greater than 2.5 mg/dl, Serum albumin less than 2.5 g/dl, Prothrombin time more than 5 seconds. […] Mild alcoholic hepatitis generally runs a benign course and is completely reversible with the cessation of alcohol consumption.
#30 Alcoholic-Associated Hepatitis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK470217/
Patients with severe alcoholic hepatitis with an MDF greater than 32 have 30-day mortality of 30% to 50%. […] Forty percent of the patients with severe alcoholic hepatitis die within 6 months after the onset of the clinical syndrome. Jaundice and hepatic encephalopathy at the time of presentation indicate a poorer outcome. […] To determine prognosis the following factors need to be considered: Histologically proven alcohol hepatitis, Serum bilirubin greater than 2.5 mg/dl, Serum albumin less than 2.5 g/dl, Prothrombin time more than 5 seconds. […] Mild alcoholic hepatitis generally runs a benign course and is completely reversible with the cessation of alcohol consumption.
#31 Alcoholic-Associated Hepatitis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK470217/
Patients with severe alcoholic hepatitis with an MDF greater than 32 have 30-day mortality of 30% to 50%. […] Forty percent of the patients with severe alcoholic hepatitis die within 6 months after the onset of the clinical syndrome. Jaundice and hepatic encephalopathy at the time of presentation indicate a poorer outcome. […] To determine prognosis the following factors need to be considered: Histologically proven alcohol hepatitis, Serum bilirubin greater than 2.5 mg/dl, Serum albumin less than 2.5 g/dl, Prothrombin time more than 5 seconds. […] Mild alcoholic hepatitis generally runs a benign course and is completely reversible with the cessation of alcohol consumption.
#32 Alcohol-Induced Hepatitis: Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/17853-alcoholic-hepatitis
If its not too far advanced, it can be reversed by quitting alcohol. Those who dont quit will continue to progress toward cirrhosis and liver failure. […] People who quit drinking alcohol after diagnosis show great improvement after six to 12 months. Milder cases often resolve completely. More severe cases can continue to show gradual improvement over the following years. […] If you dont stop drinking after diagnosis, you have a reduced life expectancy. For men who dont stop drinking, the five-year survival rate is about 70%. For women who dont stop drinking, its 30%. People with severe alcohol-induced hepatitis and advanced liver disease have poorer outcomes. Up to 40% of people with severe alcohol-induced hepatitis die within six months of diagnosis.
#33 Alcohol-Induced Hepatitis: Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/17853-alcoholic-hepatitis
If its not too far advanced, it can be reversed by quitting alcohol. Those who dont quit will continue to progress toward cirrhosis and liver failure. […] People who quit drinking alcohol after diagnosis show great improvement after six to 12 months. Milder cases often resolve completely. More severe cases can continue to show gradual improvement over the following years. […] If you dont stop drinking after diagnosis, you have a reduced life expectancy. For men who dont stop drinking, the five-year survival rate is about 70%. For women who dont stop drinking, its 30%. People with severe alcohol-induced hepatitis and advanced liver disease have poorer outcomes. Up to 40% of people with severe alcohol-induced hepatitis die within six months of diagnosis.
#34 Alcohol-Induced Hepatitis: Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/17853-alcoholic-hepatitis
If its not too far advanced, it can be reversed by quitting alcohol. Those who dont quit will continue to progress toward cirrhosis and liver failure. […] People who quit drinking alcohol after diagnosis show great improvement after six to 12 months. Milder cases often resolve completely. More severe cases can continue to show gradual improvement over the following years. […] If you dont stop drinking after diagnosis, you have a reduced life expectancy. For men who dont stop drinking, the five-year survival rate is about 70%. For women who dont stop drinking, its 30%. People with severe alcohol-induced hepatitis and advanced liver disease have poorer outcomes. Up to 40% of people with severe alcohol-induced hepatitis die within six months of diagnosis.
#35 Alcoholic Hepatitis: Diagnosis and Management | AAFP
https://www.aafp.org/pubs/afp/issues/2022/0400/p412.html
The Lille score distinguishes patients who would likely be responsive vs. unresponsive to steroids, predicting who could have poorer outcomes if steroid therapy was continued beyond seven days. […] Corticosteroid use should be discontinued in patients who do not show an initial response (i.e., Lille score of 0.45 or more on day 7). […] If the Lille score suggests responsiveness, the corticosteroid dose should be continued for a total of 28 days and then tapered. […] There is growing support for early liver transplantation in some patients with severe alcoholic hepatitis, rather than requiring six months of alcohol abstinence and engagement in alcohol cessation counseling. […] Ongoing treatment of alcohol use disorder is paramount to long-term survival of patients with alcoholic hepatitis.
#36 Alcoholic Hepatitis: Diagnosis and Management | AAFP
https://www.aafp.org/pubs/afp/issues/2022/0400/p412.html
The Lille score distinguishes patients who would likely be responsive vs. unresponsive to steroids, predicting who could have poorer outcomes if steroid therapy was continued beyond seven days. […] Corticosteroid use should be discontinued in patients who do not show an initial response (i.e., Lille score of 0.45 or more on day 7). […] If the Lille score suggests responsiveness, the corticosteroid dose should be continued for a total of 28 days and then tapered. […] There is growing support for early liver transplantation in some patients with severe alcoholic hepatitis, rather than requiring six months of alcohol abstinence and engagement in alcohol cessation counseling. […] Ongoing treatment of alcohol use disorder is paramount to long-term survival of patients with alcoholic hepatitis.
#37 Alcoholic Hepatitis: Diagnosis and Management | AAFP
https://www.aafp.org/pubs/afp/issues/2022/0400/p412.html
The Lille score distinguishes patients who would likely be responsive vs. unresponsive to steroids, predicting who could have poorer outcomes if steroid therapy was continued beyond seven days. […] Corticosteroid use should be discontinued in patients who do not show an initial response (i.e., Lille score of 0.45 or more on day 7). […] If the Lille score suggests responsiveness, the corticosteroid dose should be continued for a total of 28 days and then tapered. […] There is growing support for early liver transplantation in some patients with severe alcoholic hepatitis, rather than requiring six months of alcohol abstinence and engagement in alcohol cessation counseling. […] Ongoing treatment of alcohol use disorder is paramount to long-term survival of patients with alcoholic hepatitis.
#38 Prognostic Value of the Alcoholic Hepatitis Histologic Score in Korean Patients with Biopsy-Proven Alcoholic Hepatitis
https://www.gutnliver.org/journal/view.html?volume=14&number=5&spage=636
The alcoholic hepatitis histologic score (AHHS) is a recently developed clinical model for predicting short-term mortality in Caucasian patients with alcoholic hepatitis (AH). The AHHS has not been extensively validated in other ethnic populations. This study validated the AHHS in a Korean patient cohort. […] None of the individual AHHS components were associated with 3-month mortality. However, the bilirubinostasis type and fibrosis severity were significantly associated with AH mortality beyond 6 months. […] In this prospective Korean AH cohort, the modified AHHS was significantly associated with overall survival (OS). Therefore, the AHHS might be a useful histological prognosticator for long-term prognosis in patients with nonsevere AH. […] The type of bilirubinostasis and severity of fibrosis were significantly associated with long-term survival greater than 6 months. The bilirubinostasis pattern and fibrosis stage were also significantly associated with OS. The AHHS was significantly associated with OS when a cutoff of 5 points was used. Therefore, these results suggest that long-term survival (as compared to short-term survival) may be predicted by the AHHS in patients with nonsevere AH. […] Our results suggest that the AHHS is a useful tool to predict long-term prognosis rather than short-term mortality in Korean patients with relatively nonsevere AH.
#39 Prognostic Value of the Alcoholic Hepatitis Histologic Score in Korean Patients with Biopsy-Proven Alcoholic Hepatitis
https://www.gutnliver.org/journal/view.html?volume=14&number=5&spage=636
The alcoholic hepatitis histologic score (AHHS) is a recently developed clinical model for predicting short-term mortality in Caucasian patients with alcoholic hepatitis (AH). The AHHS has not been extensively validated in other ethnic populations. This study validated the AHHS in a Korean patient cohort. […] None of the individual AHHS components were associated with 3-month mortality. However, the bilirubinostasis type and fibrosis severity were significantly associated with AH mortality beyond 6 months. […] In this prospective Korean AH cohort, the modified AHHS was significantly associated with overall survival (OS). Therefore, the AHHS might be a useful histological prognosticator for long-term prognosis in patients with nonsevere AH. […] The type of bilirubinostasis and severity of fibrosis were significantly associated with long-term survival greater than 6 months. The bilirubinostasis pattern and fibrosis stage were also significantly associated with OS. The AHHS was significantly associated with OS when a cutoff of 5 points was used. Therefore, these results suggest that long-term survival (as compared to short-term survival) may be predicted by the AHHS in patients with nonsevere AH. […] Our results suggest that the AHHS is a useful tool to predict long-term prognosis rather than short-term mortality in Korean patients with relatively nonsevere AH.
#40
https://journals.lww.com/cmii/fulltext/2020/18030/von_willebrand_factor__a_biomarker_to_predict.4.aspx
The aim of this study is to assess the utility of plasma von-Willebrand factor (VWF) levels in predicting in-hospital survival for patients with severe alcoholic hepatitis. […] Plasma VWF levels are markedly elevated, correlate with organ failure, and predict in-hospital survival in severe alcoholic hepatitis, and also in very severe alcoholic hepatitis, patients. […] The key finding of this study is the identification of a new biomarker to predict prognosis in severe alcoholic hepatitis patients. This new biomarker (plasma VWF) is not included in the currently used scoring systems to stratify disease severity and predict survival in severe alcoholic hepatitis patients. […] Elevated baseline plasma VWF-CBA (750 IU/dL) and fulfillment of criteria for very severe alcoholic hepatitis had an additive role in the prediction of in-hospital survival in patients with severe alcoholic hepatitis.
#41 Louisville Prognosis Criteria for Alcohol-Associated Hepatitis Severity â School of Medicine University of Louisville
https://louisville.edu/medicine/departments/medicine/divisions/gimedicine/LOUPAHS
This algorithm predicts the survival rate of the severe alcohol-associated hepatitis patients for 90-day mortality based on the biomarker activity for the ongoing liver cell death marker, K18M65. […] This criteria can be used for assessing the 90-day mortality among the alcohol-associated liver disease patients, who have reached the stage of severe alcoholic hepatitis. […] Recommendation for medical management strategies in severe alcohol-associated hepatitis patients. […] The algorithm is specific for severe Alcohol-Associated Hepatitis designed for survivability. […] Survival landmark: Favorable Indication of Prognosis – K18M652629.4 IU/L.
#42 Alcohol-Induced Hepatitis: Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/17853-alcoholic-hepatitis
If its not too far advanced, it can be reversed by quitting alcohol. Those who dont quit will continue to progress toward cirrhosis and liver failure. […] People who quit drinking alcohol after diagnosis show great improvement after six to 12 months. Milder cases often resolve completely. More severe cases can continue to show gradual improvement over the following years. […] If you dont stop drinking after diagnosis, you have a reduced life expectancy. For men who dont stop drinking, the five-year survival rate is about 70%. For women who dont stop drinking, its 30%. People with severe alcohol-induced hepatitis and advanced liver disease have poorer outcomes. Up to 40% of people with severe alcohol-induced hepatitis die within six months of diagnosis.
#43 Alcohol-Induced Hepatitis: Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/17853-alcoholic-hepatitis
If its not too far advanced, it can be reversed by quitting alcohol. Those who dont quit will continue to progress toward cirrhosis and liver failure. […] People who quit drinking alcohol after diagnosis show great improvement after six to 12 months. Milder cases often resolve completely. More severe cases can continue to show gradual improvement over the following years. […] If you dont stop drinking after diagnosis, you have a reduced life expectancy. For men who dont stop drinking, the five-year survival rate is about 70%. For women who dont stop drinking, its 30%. People with severe alcohol-induced hepatitis and advanced liver disease have poorer outcomes. Up to 40% of people with severe alcohol-induced hepatitis die within six months of diagnosis.
#44 Alcohol-Induced Hepatitis: Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/17853-alcoholic-hepatitis
If its not too far advanced, it can be reversed by quitting alcohol. Those who dont quit will continue to progress toward cirrhosis and liver failure. […] People who quit drinking alcohol after diagnosis show great improvement after six to 12 months. Milder cases often resolve completely. More severe cases can continue to show gradual improvement over the following years. […] If you dont stop drinking after diagnosis, you have a reduced life expectancy. For men who dont stop drinking, the five-year survival rate is about 70%. For women who dont stop drinking, its 30%. People with severe alcohol-induced hepatitis and advanced liver disease have poorer outcomes. Up to 40% of people with severe alcohol-induced hepatitis die within six months of diagnosis.
#45 Alcoholic Hepatitis: Diagnosis and Management | AAFP
https://www.aafp.org/pubs/afp/issues/2022/0400/p412.html
Laboratory-based prognostic scores, including Maddrey Discriminant Function and the Model for End-Stage Liver Disease, help determine disease severity and treatment options. […] Overall and in-hospital mortality are high for severe alcoholic hepatitis, with a 28-day mortality rate of 16% to 30% and a one-year mortality rate of 56%. […] The presence of underlying cirrhosis and continued alcohol use negatively impact long-term prognosis. […] After establishing the diagnosis of alcoholic hepatitis, clinicians should use validated laboratory-based prognostic tools to determine severity, prognosis, and treatment options. […] Severe alcoholic hepatitis is defined as a score of at least 32 using the Maddrey Discriminant Function tool or at least 21 using the Model for End-Stage Liver Disease tool.
#46 Analysis of factors predictive of mortality in alcoholic hepatitis and derivation and validation of the Glasgow alcoholic hepatitis score
https://pmc.ncbi.nlm.nih.gov/articles/PMC1774903/
Alcoholic hepatitis is associated with a high short term mortality. […] Using variables associated with mortality we have derived and validated an accurate scoring system to assess outcome in alcoholic hepatitis. […] This score was able to identify patients at greatest risk of death throughout their admission. […] The GAHS was derived from five variables independently associated with outcome: age (p=0.001) and, from day 1 results, serum bilirubin (p0.001), blood urea (p=0.019) and, from day 69 results, serum bilirubin (p0.001), prothrombin time (p=0.002), and peripheral blood white blood cell count (p=0.001). […] Overall survival was 77% and 68% at days 28 and 84, respectively. […] Patients with an admission mDF of 32 had a survival of 71% and 62% at days 28 and 84, respectively.
#47
https://journals.lww.com/cmii/fulltext/2020/18030/von_willebrand_factor__a_biomarker_to_predict.4.aspx
The aim of this study is to assess the utility of plasma von-Willebrand factor (VWF) levels in predicting in-hospital survival for patients with severe alcoholic hepatitis. […] Plasma VWF levels are markedly elevated, correlate with organ failure, and predict in-hospital survival in severe alcoholic hepatitis, and also in very severe alcoholic hepatitis, patients. […] The key finding of this study is the identification of a new biomarker to predict prognosis in severe alcoholic hepatitis patients. This new biomarker (plasma VWF) is not included in the currently used scoring systems to stratify disease severity and predict survival in severe alcoholic hepatitis patients. […] Elevated baseline plasma VWF-CBA (750 IU/dL) and fulfillment of criteria for very severe alcoholic hepatitis had an additive role in the prediction of in-hospital survival in patients with severe alcoholic hepatitis.
#48 Louisville Prognosis Criteria for Alcohol-Associated Hepatitis Severity â School of Medicine University of Louisville
https://louisville.edu/medicine/departments/medicine/divisions/gimedicine/LOUPAHS
This algorithm predicts the survival rate of the severe alcohol-associated hepatitis patients for 90-day mortality based on the biomarker activity for the ongoing liver cell death marker, K18M65. […] This criteria can be used for assessing the 90-day mortality among the alcohol-associated liver disease patients, who have reached the stage of severe alcoholic hepatitis. […] Recommendation for medical management strategies in severe alcohol-associated hepatitis patients. […] The algorithm is specific for severe Alcohol-Associated Hepatitis designed for survivability. […] Survival landmark: Favorable Indication of Prognosis – K18M652629.4 IU/L.
#49 Alcoholic Hepatitis: Diagnosis and Management | AAFP
https://www.aafp.org/pubs/afp/issues/2022/0400/p412.html
The Lille score distinguishes patients who would likely be responsive vs. unresponsive to steroids, predicting who could have poorer outcomes if steroid therapy was continued beyond seven days. […] Corticosteroid use should be discontinued in patients who do not show an initial response (i.e., Lille score of 0.45 or more on day 7). […] If the Lille score suggests responsiveness, the corticosteroid dose should be continued for a total of 28 days and then tapered. […] There is growing support for early liver transplantation in some patients with severe alcoholic hepatitis, rather than requiring six months of alcohol abstinence and engagement in alcohol cessation counseling. […] Ongoing treatment of alcohol use disorder is paramount to long-term survival of patients with alcoholic hepatitis.
#50 Alcohol-Induced Hepatitis: Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/17853-alcoholic-hepatitis
If its not too far advanced, it can be reversed by quitting alcohol. Those who dont quit will continue to progress toward cirrhosis and liver failure. […] People who quit drinking alcohol after diagnosis show great improvement after six to 12 months. Milder cases often resolve completely. More severe cases can continue to show gradual improvement over the following years. […] If you dont stop drinking after diagnosis, you have a reduced life expectancy. For men who dont stop drinking, the five-year survival rate is about 70%. For women who dont stop drinking, its 30%. People with severe alcohol-induced hepatitis and advanced liver disease have poorer outcomes. Up to 40% of people with severe alcohol-induced hepatitis die within six months of diagnosis.