Liver, Pancreas, and Biliary TractPentoxifylline improves short-term survival in severe acute alcoholic hepatitis: A double-blind, placebo-controlled trial☆,☆☆
Section snippets
Patient selection
The study was performed on patients hospitalized between August 1992 and May 1997 in the Liver Unit of the University of Southern California at Rancho Los Amigos Medical Center, in Downey, California. The study was approved by the Institutional Review Board before its initiation and periodically thereafter during the 5-year period of its conductance. Informed consent was obtained from all participating patients. Each patient had a history of heavy ethanol abuse and an admission diagnosis of
Patient characteristics
One hundred two patients were enrolled. There was 1 dropout: a patient from the PTX group left the hospital against medical advice 1 day after randomization. He received only 3 capsules of PTX and therefore was excluded from analysis. Of the remaining 101 patients, 49 (35 men and 14 women) received PTX and 52 (40 men and 12 women) received placebo. Mean age was 42.4 ± 8.2 years for the PTX group and 40.8 ± 8.7 years for the control group (P = 0.36; Table 1).
Demographic and clinical
Discussion
Increased production of TNF by monocytes12 and Kupffer cells20 has been reported in patients with acute alcoholic hepatitis, and levels of TNF correlated with mortality in some studies.7 Predisposition for alcoholinduced steatohepatitis appears to be genetically determined through increased TNF gene expression.21 TNF can cause hepatocyte injury either directly by binding to cytokine receptors or indirectly by attracting and activating neutrophils.22, 23, 24 Administration of human recombinant
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No reprints available.
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Financial support for TNF measurements was kindly provided by Hoeschst-Roussel Pharmaceuticals Inc.