Prognosis of treated severe alcoholic hepatitis in patients with gastrointestinal bleeding

Marika Rudler; Sarah Mouri; Frédéric Charlotte; Pascal Lebray; Romain Capocci; Hedi Benosman; Thierry Poynard; Dominique Thabut

doi:10.1016/j.jhep.2014.11.003

Prognosis of treated severe alcoholic hepatitis in patients with gastrointestinal bleeding

J Hepatol. 2015 Apr;62(4):816-21. doi: 10.1016/j.jhep.2014.11.003. Epub 2014 Nov 11.

Authors

Marika Rudler¹, Sarah Mouri¹, Frédéric Charlotte², Pascal Lebray¹, Romain Capocci¹, Hedi Benosman¹, Thierry Poynard¹, Dominique Thabut³

Affiliations

¹ AP-HP, UPMC, Department of Hepatogastroenterology, La Pitié-Salpêtrière Hospital, 47-80 boulevard de l'Hôpital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie University, 75013 Paris, France.
² AP-HP, UPMC, Department of Anatomopathology, La Pitié-Salpêtrière Hospital, 47-80 boulevard de l'Hôpital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie University, 75013 Paris, France.
³ AP-HP, UPMC, Department of Hepatogastroenterology, La Pitié-Salpêtrière Hospital, 47-80 boulevard de l'Hôpital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie University, 75013 Paris, France. Electronic address: dominique.thabut@psl.aphp.fr.

PMID: 25450199
DOI: 10.1016/j.jhep.2014.11.003

Abstract

Background & aims: All trials on severe alcoholic hepatitis (AH) have included patients with "pure" AH, i.e., without concomitant gastrointestinal bleeding (GIB). Severe AH is often suspected in cirrhotic patients with GIB. We aimed at (1) assessing the prevalence of AH in patients with GIB and Maddrey discriminant function (DF) ⩾32; (2) comparing the outcome in AH patients with or without GIB (AH-GIB+, AH-GIB-); and (3) assessing the performance of the Lille model for survival in AH-GIB+ patients.

Methods: We retrospectively included all patients with alcoholic cirrhosis admitted between January 2005 and March 2011 with the following: (1) jaundice <3 months; (2) DF ⩾32 at admission; (3) bilirubin level >50 μmol/L; and (4) active drinking. Exclusion criteria were advanced hepatocellular carcinoma, other etiology of cirrhosis, severe comorbidities and DF <32 after stabilization. In our centre, we systematically plan a liver biopsy for these patients. Patients with severe AH received prednisolone.

Results: We screened 161 patients (86 GIB+, 75 GIB-), and analyzed data for 58 and 47 patients in each group, respectively. The 2 groups did not differ in prevalence of AH (77.3% vs. 81%), demographic data, MELD/Child-Pugh score, or DF. The 2 groups were similar in 6-month probability of survival (73.9 ± 6.0% vs. 69.9 ± 7%, p=0.49). The probability of developing infection was lower for AH-GIB+ patients (24.1% vs. 44.7%, p=0.04). The AUC for the Lille model in predicting 6-month survival was 0.71 ± 0.06 for all patients and 0.74 ± 0.06 for AH-GIB+ patients (p>0.05).

Conclusions: Prevalence of AH is 80% for patients with cirrhosis and GIB, recent jaundice and DF ⩾32. Infection was lower for AH-GIB+ patients, which suggests a beneficial role of antibiotic prophylaxis treatment. Survival among subjects with GIB was the same as among subjects without GIB.

Keywords: Cirrhosis; Severe alcoholic hepatitis; Upper gastrointestinal bleeding.

MeSH terms

Adult
Anti-Inflammatory Agents / therapeutic use
Biopsy
Female
France / epidemiology
Gastrointestinal Hemorrhage* / epidemiology
Gastrointestinal Hemorrhage* / etiology
Hepatitis, Alcoholic* / complications
Hepatitis, Alcoholic* / diagnosis
Hepatitis, Alcoholic* / epidemiology
Hepatitis, Alcoholic* / therapy
Hospitalization / statistics & numerical data
Humans
Liver / pathology
Liver Cirrhosis* / epidemiology
Liver Cirrhosis* / etiology
Liver Function Tests / methods
Male
Middle Aged
Prednisolone / therapeutic use*
Prevalence
Prognosis
Retrospective Studies
Risk Factors
Severity of Illness Index
Survival Analysis

Substances

Anti-Inflammatory Agents
Prednisolone