Citations 1
Moderate alcohol-associated hepatitis: A real-world multicenter study
Idalsoaga, Francisco , Díaz, Luis Antonio , Dunn, Winston , Muñoz, Karen E., Caldentey, Vicente, Arnold, Jorge , Ayares, Gustavo , Mortuza, Rokhsana , Maiwall, Rakhi , Qian, Steve , Elfeki, Mohamed A. , Ramírez, Carolina , Malhi, Gurpreet, Ahmed, Adan, Homsi, Hoomam , Abid, Zinia, Echavarría, Victor, Poca, María , Cuyàs, Berta , Ventura‐Cots, Meritxell , Higuera‐de‐la‐Tijera, Fátima , Ayala-Valverde, María , Pérez, Diego , Gómez, Jaime , Abraldes, Juan, Al‐Karaghouli, Mustafa , Jalal, Prasun K. , Ibrahim, Mohamad Ali , García–Tsao, Guadalupe , Havaj, Daniel Ján , Sulejova, Karolina, Chacko, Kristina R. , Yaquich, Pamela, Toro, Luis, Shah, Vijay H. , Kamath, Patrick S. , Mehta, Heer , Arnold, Jorge , Ayares, Gustavo , Mortuza, Rokhsana , Sarin, Shiv Kumar , Maiwall, Rakhi , Qian, Steve , Simonetto, Douglas A , Singal, Ashwani K , Ramirez-Cadiz, Carolina , Poca, Maria , Soriano, German , Cuyas, Berta , Ventura Cots, Meritxell , Higuera-De La Tijera, Fatima , Ayala-Valverde, María , Jalal, Prasun K , Skladaný, Lubomir , Havaj, Daniel J , Chacko, Kristina R , Restrepo, Juan C , Shah, Vijay, Arrese, Marco , Kamath, Patrick S , Bataller, Ramon A , Díaz, Luis A , Elfeki, Mohamed A , Dunn, Winston , Echavaría, Victor , Muñoz, Karen, Zhang, Wei , Simonetto, Douglas A. , Singal, Ashwani K. , Ahmed, Adan, Abid, Zinia, Cabezas, Joaquín , Abraldeṣ, Juan G. , Goyes, Daniela , Selčanová, Světlana Adamcová , Rincón, Diego , Arrese, Marco , Arab, Juan Pablo
Hepatology Communications | March 28, 2025 | Volume: 9 | Issue: 4 | Pages: No page available
Background: Severe alcohol-associated hepatitis (sAH) is a well-characterized disease with high short-term mortality. However, there is limited research on those with a “less severe condition” (moderate AH). This study aims to characterize in-depth patients with moderate AH (mAH), including the performance of mortality scoring systems, key prognostic factors, and survival over time. Methods: A multicenter retrospective cohort study (2009–2019) included patients with mAH (MELD score ≤20 at admission). Cox regression and receiver operating characteristic curves with AUC were used for analysis. Results: We included 1845 patients with AH (20 centers, 8 countries) between 2009 and 2019. mAH was defined as a MELD score ≤20 at admission. Twenty-four percent met the criteria for an mAH episode. Patients with mAH tend to be older and have a higher proportion of females, with a median MELD of 17 (15–19), Maddrey discriminant function (mDF) of 33 (22–40), the trajectory of serum bilirubin of 0.83 (0.60–1.21), and neutrophil-to-lymphocyte ratio (NLR) of 5 (2.96–8.60). The primary causes of death in mAH included multiple organ failure (34.1%) and infections (16.6%). The cumulative survival rates at 30, 90, and 180 days were 94.3%, 90.4%, and 88.2%, respectively. In multivariable analysis, age was the only significant predictor of 30-day mortality (HR 1.49, 95% CI: 1.27–1.76, p <0.001). Mortality prediction models showed poor performance, with AUC for MELD (0.671), mDF (0.726), trajectory of serum bilirubin (0.733), and NLR (0.697). Conclusions: Patients with moderate AH exhibited a mortality of 11.8% at 6 months, primarily driven by multiple organ failure and infections. These patients also exhibit a different clinical profile compared to those with sAH. Tailored models and therapeutic strategies are needed to improve long-term outcomes in mAH.