Introduction We aimed to describe changes in survival in alcoholic hepatitis (AH) over time by examining published data.
Method A systematic literature search of Ovid Embase and PubMed was undertaken using the MESH terms ‘hepatitis, alcoholic’ to identify randomised controlled trials (RCT) and observational studies (OS) in alcoholic hepatitis. Data were extracted from included studies regarding 28 day, 90 day, 180 day mortality, as well as biochemical and clinical data.
Results After review of the literature search results, 79 studies published between 1971 and 2016 were analysed, which included data from a total of 8318 patients. Overall mortality from AH was 25% at 28 days, 29% at 90 days and 38% at 180 days after admission. No changes in mortality over time were observed in univariable analysis at 28 days or 90 days after admission (Pearson correlation r −0.207, p=0.107, and r 0.109 p=0.553 respectively) (figure 1A and 1B). A statistically significant increase in mortality was seen in 180 day mortality (r 0.446 p=0.048) (figure 1C). However, after meta-regression to adjust for other factors associated with mortality at each time point, no changes in mortality were seen. Sub-group analysis of RCT and OS did not reveal any differences between type of study.
Conclusion There has not been a significant improvement short-medium mortality from AH over the last four decades, despite much research and general medical innovation. This is not explained by changes in severity of disease. This emphasises the urgent need for effective treatments for this alcoholic hepatitis.
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