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Patidar KR, Guarnizo Ortiz M, Slaven JE, Nephew LD, Vilar Gomez E, Kettler CD, Ghabril MS, Desai AP, Orman ES, Chalasani N, Gawrieh S. Incidence, clinical characteristics, and risk factors associated with recurrent alcohol-associated hepatitis. Hepatol Commun 2023; 7:e0341. [PMID: 38055648 PMCID: PMC10984669 DOI: 10.1097/hc9.0000000000000341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/25/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Alcohol relapse occurs frequently in alcohol-associated hepatitis (AH) survivors, but data on the frequency and course of recurrent alcohol-associated hepatitis (rAH) are sparse. We investigated the incidence, risk factors, and outcomes of rAH. METHODS Hospitalized patients with AH from 2010 to 2020 at a large health care system were followed until death/liver transplant, last follow-up, or end of study (December 31, 2021). AH was defined by NIAAA Alcoholic Hepatitis Consortium criteria; rAH was defined a priori as a discrete AH episode >6 months from index AH hospitalization with interim >50% improvement or normalization of total bilirubin. Multivariable competing risk analysis was performed to identify factors associated with rAH. Landmark Kaplan-Meier analysis was performed to compare survival between patients who did versus those who did not develop rAH. RESULTS Of 1504 hospitalized patients with AH, 1317 (87.6%) survived and were analyzed. During a 3055 person-year follow-up, 116 (8.8%) developed rAH at an annual incidence rate of 3.8% (95% CI: 2.8-4.8). On multivariable competing risk analysis, marital status [sub-HR 0.54 (95% CI: 0.34, 0.92), p=0.01] and medications for alcohol use disorder [sub-HR 0.56 (95% CI: 0.34, 0.91), p=0.02] were associated with a lower risk for rAH. On landmark Kaplan-Meier analysis, the cumulative proportion surviving at 1 year (75% vs. 90%) and 3 years (50% vs. 78%) was significantly lower in patients who developed rAH compared to those who did not develop rAH (log-rank p<0.001). CONCLUSIONS rAH develops in ~1 in 10 AH survivors and is associated with lower long-term survival. Medications for alcohol use disorder lower the risk for rAH and, therefore, could be a key preventative strategy to improve outcomes.
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Affiliation(s)
- Kavish R. Patidar
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Maria Guarnizo Ortiz
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - James E. Slaven
- Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, Indiana, USA
| | - Lauren D. Nephew
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Eduardo Vilar Gomez
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Carla D. Kettler
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Marwan S. Ghabril
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Archita P. Desai
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Eric S. Orman
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Naga Chalasani
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine and Indiana University Health, Indianapolis, Indiana, USA
| | - Samer Gawrieh
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Gonzalez HC, Nimri FM, Lu M, Zhou Y, Rupp LB, Trudeau S, Gordon SC. Alcohol-related hepatitis admissions decline in 2021 after a 2020 surge attributed to the COVID-19 pandemic. Hepatol Int 2023; 17:1637-1644. [PMID: 37505324 DOI: 10.1007/s12072-023-10569-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/07/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE We previously investigated the impact of the COVID-19 pandemic on alcohol-related liver disease (ARLD), finding that admissions for alcoholic hepatitis (AH) increased by 50% in the summer of 2020 compared to the same period in 2016-2019. We have now expanded our analysis to consider full years' data and evaluate how rates changed in 2021. We also sought to identify factors associated with ICU admissions, need for dialysis, liver transplant evaluations, and death. METHODS Using retrospective data, we identified patients admitted to our four Detroit, Michigan area hospitals for acute ARLD for three periods pre-COVID (2016-February 2020), early COVID (June-December 2020), and late COVID (2021). Clustered logistic regression was performed to study rates of AH admissions across the three eras, where the patient was defined as the cluster and the analysis accounted for multiple encounters per cluster. A similar regression approach, univariate followed by multivariable analysis, was also used to study associations between patient characteristics and outcomes during hospitalization for AH. RESULTS AH-related admissions declined significantly from the early COVID to late COVID eras (OR 0.68, 95% CL 0.52, 0.88), returning to levels similar to that of the pre- COVID period (OR 1.18, 95% CL 0.96, 1.47). In multivariable analysis, baseline MELD score was associated with ICU admission, initiation of dialysis, transplant evaluation, and death while hospitalized for AH. Female patients were at almost twice the risk of death during admission compared to male patients (aOR 1.81, 95% CL 1.1, 2.98). Increasing age was associated with slightly lower odds of transplant (aOR 0.97, 95% CL 0.94, 1) and higher odds of death (aOR 1.03, 95% CL 1.01. 1.06). CONCLUSION After a spike in AH-related admissions during the first summer of the COVID-19 pandemic, rates declined significantly in 2021, returning to pre-pandemic levels.
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Affiliation(s)
- Humberto C Gonzalez
- Department of Gastroenterology and Hepatology, Henry Ford Health, Detroit, MI, USA.
- School of Medicine, Wayne State University, Detroit, MI, USA.
- Transplant Hepatology, Henry Ford Health, 2799 West Grand Blvd, Detroit, MI, 48202, USA.
| | - Faisal M Nimri
- Department of Gastroenterology and Hepatology, Henry Ford Health, Detroit, MI, USA
| | - Mei Lu
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI, USA
| | - Yueren Zhou
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI, USA
| | - Loralee B Rupp
- Department of Health Policy and Health Systems Research, Henry Ford Health, Detroit, MI, USA
| | - Sheri Trudeau
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI, USA
| | - Stuart C Gordon
- Department of Gastroenterology and Hepatology, Henry Ford Health, Detroit, MI, USA
- School of Medicine, Wayne State University, Detroit, MI, USA
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Pemmasani G, Tremaine WJ, Suresh Kumar VC, Aswath G, Sapkota B, Karagozian R, John S. Sex differences in clinical characteristics and outcomes associated with alcoholic hepatitis. Eur J Gastroenterol Hepatol 2023; 35:1192-1196. [PMID: 37577797 DOI: 10.1097/meg.0000000000002612] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
BACKGROUND Alcohol-associated liver disease is increasing among females with an earlier onset and more severe disease at lower levels of exposure. However, there is paucity of literature regarding sex differences related to alcoholic hepatitis. METHODS Hospitalized patients with alcoholic hepatitis were selected from the US Nationwide readmissions database 2019. In this cohort, we evaluated sex differences in baseline comorbidities, alcoholic hepatitis related complications and mortality. A subset of patients with alcoholic hepatitis who were hospitalized between January and June 2019 were identified to study sex differences in 6 month readmission rate, mortality during readmission, and composite of mortality during index hospitalization or readmission. RESULTS Among 112 790 patients with alcoholic hepatitis, 33.3% were female. Female patients were younger [48 (38-57) vs. 49 (39-58) years; both P < 0.001] but had higher rates of important medical and mental-health related comorbidities. Compared with males, females had higher rates of hepatic encephalopathy (11.5% vs. 10.1; P < 0.001), ascites (27.9% vs. 22.5%; P < 0.001), portal hypertension (18.5% vs. 16.4%; P < 0.001), cirrhosis (37.3% vs. 31.9%; P < 0.001), weight loss (19.0% vs. 14.5%; P < 0.001), hepatorenal syndrome (4.4% vs. 3.8%; P < 0.001), spontaneous bacterial peritonitis (1.9% vs. 1.7%; P = 0.026), sepsis (11.1% vs. 9.5%; P < 0.001), and blood transfusion (12.9% vs. 8.7%; P < 0.001). Females had a similar in-hospital mortality rate (4.3%) compared to males (4.1%; P = 0.202; adjusted odds ratio (OR) 1.02, 95% CI (cardiac index) 0.89-1.15; P = 0.994). In the subset of patients ( N = 58 688), females had a higher 6-month readmission rate (48.9% vs. 44.9%; adjusted OR 1.12 (1.06-1.18); P < 0.001), mortality during readmission (4.4% vs. 3.2%; OR 1.23 (1.08-1.40); P < 0.01), and composite of mortality during index hospitalization or readmission (8.7% vs. 7.2%; OR 1.15 (1.04-1.27); P < 0.01). CONCLUSION Compared to their male counterparts, females with alcoholic hepatitis were generally younger but had higher rates of comorbidities, alcoholic hepatitis related complications, rehospitalizations and associated mortality. The greater risks of alcohol-associated liver dysfunction in females indicate the need for more aggressive management.
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Affiliation(s)
- Gayatri Pemmasani
- Division of Gastroenterology and Hepatology, SUNY Upstate Medical University, Syracuse, New York
| | - William J Tremaine
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesto
| | | | - Ganesh Aswath
- Division of Gastroenterology and Hepatology, SUNY Upstate Medical University, Syracuse, New York
| | - Bishnu Sapkota
- Division of Gastroenterology and Hepatology, SUNY Upstate Medical University, Syracuse, New York
| | - Raffi Karagozian
- Division of Gastroenterology and Hepatology, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Savio John
- Division of Gastroenterology and Hepatology, SUNY Upstate Medical University, Syracuse, New York
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Björnsson ES, Johannsson A, Sigurdarson SS, Hreinsson JP, Runarsdottir V. Development of severe alcohol related liver disease over four decades in Iceland: impact of increased access and use of alcohol. Scand J Gastroenterol 2023; 58:1523-1533. [PMID: 37551903 DOI: 10.1080/00365521.2023.2245939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/03/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE Limited data exist on the association between per capita alcohol consumption and incidence of alcohol related liver disease (ARLD). The aims were to analyse this relationship and assess prevalence of ARLD in Iceland and among patients treated for alcohol use disorder (AUD) and its impact on outcomes. METHODS A retrospective study on all patients diagnosed with severe ARLD: alcohol related cirrhosis (ARC) and alcohol related hepatitis (ARH) in Iceland 1984-2020. Medical records were scrutinized for clinical features, severity of ARLD, proportion undergoing treatment for AUD, data on abstinence and long-term outcomes. RESULTS A total of 314 patients, males 76%, median age 56 years, fulfilled the predetermined criteria for ARLD. Median MELD was 17, 73% with Child-Pugh B/C and 70/314 (22%) who had ARH. Incidence of ARLD increased from 0.77 cases per 100 000 inhabitants annually 1984-2000 to 6.1 per 100 000 in 2016-2020. Per capita alcohol consumption increased from 4.3 Liters to 7.5 L in in the same time periods. Overall 220/314 (70%) with ARLD had undergone treatment for AUD. Of all individuals who had AUD treatment during the study period (n = 21.845), 1% were diagnosed with ARLD. Patients who underwent treatment for AUD after the ARLD diagnosis had better prognosis than those who had treatment prior to ARLD diagnosis (hazard ratio 2.5 [95% CI 1.3-5.0]). CONCLUSIONS The incidence of ARLD increased 8-fold during the study period coinciding with 74% increase in per capita alcohol consumption. Patients with prior diagnosis of AUD had worse prognosis that needs special attention.
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Affiliation(s)
- E S Björnsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Divison of Gastroenterology, Landspitali University Hospital, Reykjavik, Iceland
| | - A Johannsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - S S Sigurdarson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - J P Hreinsson
- Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - V Runarsdottir
- National Center of Addiction Medicine, Vogur Hospital, Reykjavik, Iceland
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Chaudhry H, Sohal A, Iqbal H, Roytman M. Alcohol-related hepatitis: A review article. World J Gastroenterol 2023; 29:2551-2570. [PMID: 37213401 PMCID: PMC10198060 DOI: 10.3748/wjg.v29.i17.2551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/10/2023] [Accepted: 04/13/2023] [Indexed: 05/23/2023] Open
Abstract
Alcohol-related hepatitis (ARH) is a unique type of alcohol-associated liver disease characterized by acute liver inflammation caused by significant alcohol use. It ranges in severity from mild to severe and carries significant morbidity and mortality. The refinement of scoring systems has enhanced prognostication and guidance of clinical decision-making in the treatment of this complex disease. Although treatment focuses on supportive care, steroids have shown benefit in select circumstances. There has been a recent interest in this disease process, as coronavirus disease 2019 pandemic led to substantial rise in cases. Although much is known regarding the pathogenesis, prognosis remains grim due to limited treatment options. This article summarizes the epidemiology, genetics, pathogenesis, diagnosis and treatment of ARH.
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Affiliation(s)
- Hunza Chaudhry
- Department of Internal Medicine, University of California, San Francisco, Fresno, CA 93701, United States
| | - Aalam Sohal
- Department of Hepatology, Liver Institute Northwest, Seattle, WA 98105, United States
| | - Humzah Iqbal
- Department of Internal Medicine, University of California, San Francisco, Fresno, CA 93701, United States
| | - Marina Roytman
- Department of Gastroenterology and Hepatology, University of California, San Francisco, Fresno, CA 93701, United States
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Marlowe N, Lin WQ, Liangpunsakul S. Reporting the cases of alcohol-associated hepatitis using the National Inpatient Sample data. World J Gastroenterol 2023; 29:1648-1650. [PMID: 36970594 PMCID: PMC10037249 DOI: 10.3748/wjg.v29.i10.1648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/29/2022] [Accepted: 03/02/2023] [Indexed: 03/14/2023] Open
Abstract
The letter is to respond to the recent publication “Trends in hospitalization for alcoholic hepatitis from 2011 to 2017: A USA nationwide study” (World J Gastroenterol 2022; 28: 5036-5046). We noticed a significant difference in the total numbers of reported hospitalized alcohol-associated hepatitis (AH) patients between this publication and our publication on Alcohol Clin Exp Res (2022; 46: 1472-1481). We believe the number of “AH-related hospitalizations” inflated by the inclusion of patients with non-AH forms of alcohol-associated liver disease.
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Affiliation(s)
| | - Wei-Qi Lin
- Durect Corporation, Cupertino, CA 95014, United States
| | - Suthat Liangpunsakul
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University, Indianapolis, IN 46202, United States
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Wakil A, Mohamed M, Tafesh Z, Niazi M, Olivo R, Xia W, Greenberg P, Pyrsopoulos N. Trends in hospitalization for alcoholic hepatitis from 2011 to 2017: A USA nationwide study. World J Gastroenterol 2022; 28:5036-5046. [PMID: 36160652 PMCID: PMC9494933 DOI: 10.3748/wjg.v28.i34.5036] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/01/2022] [Accepted: 07/25/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Severe alcoholic hepatitis (AH) is one of the most lethal manifestations of alcohol-associated liver disease. In light of the increase in alcohol consumption worldwide, the incidence of AH is on the rise, and data examining the trends of AH admission is needed.
AIM To examine inpatient admission trends secondary to AH, along with their clinical outcomes and epidemiological characteristics.
METHODS The National Inpatient Sample (NIS) database was utilized, and data from 2011 to 2017 were reviewed. We included individuals aged ≥ 21 years who were admitted with a primary or secondary diagnosis of AH using the International Classification of Diseases (ICD)-9 and its correspondent ICD-10 codes. Hepatitis not related to alcohol was excluded. The national estimates of inpatient admissions were obtained using sample weights provided by the NIS.
RESULTS AH-related hospitalization demonstrated a significant increase in the USA from 281506 (0.7% of the total admission in 2011) to 324050 (0.9% of the total admission in 2017). The median age was 54 years. The most common age group was 45–65 years (range 57.8%–60.7%). The most common race was white (63.2%–66.4%), and patients were predominantly male (69.7%–71.2%). The primary healthcare payers were Medicare (29.4%–30.7%) and Medicaid (21.5%–32.5%). The most common geographical location was the Southern USA (33.6%–34.4%). Most patients were admitted to a tertiary care center (50.2%–62.3%) located in urban areas. Mortality of AH in this inpatient sample was 5.3% in 2011 and 5.5% in 2017. The most common mortality-associated risk factors were acute renal failure (59.6%–72.1%) and gastrointestinal hemorrhage (17.2%–20.3%). The total charges were noted to range between $25242.62 and $34874.50.
CONCLUSION The number of AH inpatient hospitalizations significantly increased from 2011 to 2017. This could have a substantial financial impact with increasing healthcare costs and utilization. AH-mortality remained the same.
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Affiliation(s)
- Ali Wakil
- Department of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Mujtaba Mohamed
- Department of Gastroenterology and Hepatology, Marshall University Hospital, Huntington, WV 25701, USA
| | - Zaid Tafesh
- Department of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Mumtaz Niazi
- Department of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Raquel Olivo
- Department of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Weiyi Xia
- Department of Biostatistics & Epidemiology, Rutgers School of Public Health, Piscataway, NJ 08854, USA
| | - Patricia Greenberg
- Department of Biostatistics & Epidemiology, Rutgers School of Public Health, Piscataway, NJ 08854, USA
| | - Nikolaos Pyrsopoulos
- Department of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
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Panchal SA, Kaplan DE, Goldberg DS, Mahmud N. Algorithms to Identify Alcoholic Hepatitis Hospitalizations in Patients with Cirrhosis. Dig Dis Sci 2022; 67:4395-4402. [PMID: 35022905 PMCID: PMC9276834 DOI: 10.1007/s10620-021-07321-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/08/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Alcoholic hepatitis (AH) is a clinically diagnosed syndrome with high short-term mortality for which liver transplantation may be curative. A lack of validated algorithms to identify AH hospitalizations has hindered clinical epidemiology research. METHODS This was a retrospective cohort study of patients with cirrhosis using Veterans Health Administration (VHA) data from 2008 to 2015. We randomly sampled hospitalizations based upon abnormal liver tests and administrative codes for acute hepatitis or alcohol-associated liver disease (ALD). Hospitalizations were manually adjudicated for AH per society guidelines. A priori algorithms were evaluated to compute positive predicted value (PPV) and positive likelihood ratio (LR+), and were tested in an external University of Pennsylvania Health System (UPHS) cohort. RESULTS Of 368 hospitalizations, 142 (38.6%) were adjudicated as AH. AH patients were younger (55 vs. 58 years, p < 0.001), less likely to have prior cirrhosis decompensation (57% vs. 73.9%, p < 0.001), and had higher AST-to-ALT ratios (median 2.9 vs. 1.9 mg/dL, p < 0.001) and higher bilirubin levels (median 2.9 vs. 1.9 mg/dL, p < 0.001). Algorithms combining clinical laboratory criteria (AST > 85 U/L but < 450 U/L, AST-to-ALT ratio > 2, total bilirubin > 5 mg/dL) and administrative coding criteria yielded the highest PPV (96.4%, 95% CI 87.7-99.6) and the highest LR+ (43.0, 95% CI 10.6-173.5). Several algorithms demonstrated 100% PPV for definite AH in the UPHS external cohort. CONCLUSION We have identified algorithms for AH hospitalizations with excellent PPV and LR+. These high-specificity algorithms may be used in VHA datasets to identify patients with high likelihood of AH, but should not be used to study AH incidence.
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Affiliation(s)
- Sarjukumar A Panchal
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David E Kaplan
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, 4th Floor, South Pavilion, Philadelphia, PA, 19104, USA
- Department of Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - David S Goldberg
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nadim Mahmud
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, 4th Floor, South Pavilion, Philadelphia, PA, 19104, USA.
- Department of Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.
- Leonard David Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA.
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Bertha M, Shedden K, Mellinger J. Trends in the inpatient burden of alcohol-related liver disease among women hospitalized in the United States. Liver Int 2022; 42:1557-1561. [PMID: 35451173 DOI: 10.1111/liv.15277] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/23/2022] [Accepted: 04/08/2022] [Indexed: 12/13/2022]
Abstract
Alcohol-related liver disease (ALD) is the leading indication for liver transplantation in the United States, but disparities for women with ALD exist. We sought to characterize trends in ALD hospitalizations and mortality among women. Using the National Inpatient Sample, we evaluated ALD and non-ALD discharges from 2003 to 2017. Multivariable logistic regression was used to evaluate mortality. ALD increased more rapidly among women, with alcohol hepatitis (AH) rising the most. When stratified by age and sex, changes in alcohol-related cirrhosis (AC) and AH were greater in women in nearly all age groups. Similar increases were present when stratified by race, notably for Native American and Asian women. AH mortality increased in women in almost all age groups. While ALD remains predominantly male, discharges and mortality have disproportionately increased among women, particularly in young women and Native Americans. These findings shed light on populations in need of intensive public health interventions.
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Affiliation(s)
- Madeline Bertha
- Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kerby Shedden
- Department of Statistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Jessica Mellinger
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
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Lee DU, Fan GH, Hastie DJ, Addonizio EA, Prakasam VN, Ahern RR, Seog KJ, Karagozian R. The Impact of Malnutrition on the Hospital and Infectious Outcomes of Patients Admitted With Alcoholic Hepatitis: 2011 to 2017 Analysis of US Hospitals. J Clin Gastroenterol 2022; 56:349-359. [PMID: 33769393 DOI: 10.1097/mcg.0000000000001528] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/06/2021] [Indexed: 01/13/2023]
Abstract
GOALS We specifically evaluate the effect of malnutrition on the infection risks of patients admitted with alcoholic hepatitis using a national registry of hospitalized patients in the United States. BACKGROUND Malnutrition is a common manifestation of alcoholic hepatitis that affects patient outcomes. STUDY 2011 to 2017 National Inpatient Sample was used to isolated patients with alcoholic hepatitis, stratified using malnutrition (protein-calorie malnutrition, sarcopenia, and weight loss/cachexia) and matched using age, gender, and race with 1:1 nearest neighbor matching method. Endpoints included mortality and infectious endpoints. RESULTS After matching, there were 10,520 with malnutrition and 10,520 malnutrition-absent controls. Mortality was higher in the malnutrition cohort [5.02 vs. 2.29%, P<0.001, odds ratio (OR): 2.25, 95% confidence interval (CI): 1.93-2.63], as were sepsis (14.2 vs. 5.46, P<0.001, OR: 2.87, 95% CI: 2.60-3.18), pneumonia (10.9 vs. 4.63%, P<0.001, OR: 2.51, 95% CI: 2.25-2.81), urinary tract infection (14.8 vs. 9.01%, P<0.001, OR: 1.76, 95% CI: 1.61-1.91), cellulitis (3.17 vs. 2.18%, P<0.001, OR: 1.47, 95% CI: 1.24-1.74), cholangitis (0.52 vs. 0.20%, P<0.001, OR: 2.63, 95% CI: 1.59-4.35), and Clostridium difficile infection (1.67 vs. 0.91%, P<0.001, OR: 1.85, 95% CI: 1.44-2.37). In multivariate models, malnutrition was associated with mortality [P<0.001, adjusted odds ratio (aOR): 1.61, 95% CI: 1.37-1.90] and infectious endpoints: sepsis (P<0.001, aOR: 2.42, 95% CI: 2.18-2.69), pneumonia (P<0.001, aOR: 2.19, 95% CI: 1.96-2.46), urinary tract infection (P<0.001, aOR: 1.68, 95% CI: 1.53-1.84), cellulitis (P<0.001, aOR: 1.46, 95% CI: 1.22-1.74), cholangitis (P=0.002, aOR: 2.27, 95% CI: 1.36-3.80), and C. difficile infection (P<0.001, aOR: 1.89, 95% CI: 1.46-2.44). CONCLUSION This study shows the presence of malnutrition is an independent risk factor of mortality and local/systemic infections in patients admitted with alcoholic hepatitis.
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Affiliation(s)
- David U Lee
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Washington Street, Boston, MA
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11
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Sohal A, Khalid S, Green V, Gulati A, Roytman M. The Pandemic Within the Pandemic: Unprecedented Rise in Alcohol-related Hepatitis During the COVID-19 Pandemic. J Clin Gastroenterol 2022; 56:e171-e175. [PMID: 34653062 PMCID: PMC8843054 DOI: 10.1097/mcg.0000000000001627] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/21/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM The third leading preventable cause of death in the United States is excessive alcohol consumption. Our study sought to assess the impact of the coronavirus disease 2019 (COVID-19) on hospitalizations for alcohol-related hepatitis at a community hospital system. We hypothesized an increase in cases of alcohol-related hepatitis requiring inpatient management, mirroring the strain on economic and societal norms imposed by the COVID-19 pandemic. APPROACH/RESULTS We performed a retrospective chart review to study the incidence of alcohol-related hepatitis in patients presenting to 3 community hospitals in Fresno, California, before and during the COVID-19. Data including patient demographics, markers of disease severity, and clinical course were extracted from electronic medical records for 329 patients included in the study. There was a 51% increase in the overall incidence of alcohol-related hepatitis requiring hospitalization between 2019 and 2020 (P=0.003) and 69% increase (P<0.001) after implementation of the stay-at-home orders. In addition, 94% (P=0.028) increase in rehospitalizations was noted in 2020 (P=0.028), a 100% increase in patients under the age of 40 (P=0.0028), as well as a trend towards a 125% increase (P=0.06) of female patients admitted with this diagnosis during the COVID-19 pandemic. CONCLUSIONS Our study revealed drastic increases in severe alcohol-related hepatitis requiring inpatient management, specifically in patients under the age of 40 and in women during the COVID-19 pandemic. Given the high morbidity and mortality associated with severe alcohol-related hepatitis, these findings have far-reaching and lasting implications for our already strained health care system extending beyond the COVID-19 pandemic timeframe. Urgent public health interventions are needed to combat the rising misuse of alcohol and its consequences.
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Affiliation(s)
| | | | | | - Alakh Gulati
- Gastroenterology and Hepatology, UCSF Fresno, Fresno, CA
| | - Marina Roytman
- Gastroenterology and Hepatology, UCSF Fresno, Fresno, CA
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12
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Musto JA, Eickhoff J, Ventura-Cots M, Abraldes JG, Bosques-Padilla F, Verna EC, Brown RS, Vargas V, Altamirano J, Caballería J, Shawcross D, Louvet A, Mathurin P, Garcia-Tsao G, Schnabl B, Bataller R, Lucey MR. The Level of Alcohol Consumption in the Prior Year Does Not Impact Clinical Outcomes in Patients With Alcohol-Associated Hepatitis. Liver Transpl 2021; 27:1382-1391. [PMID: 34109723 DOI: 10.1002/lt.26203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/19/2021] [Accepted: 05/03/2021] [Indexed: 12/13/2022]
Abstract
The 10-item Alcohol Use Disorders Identification Test (AUDIT-10) and its shorter form, AUDIT-Consumption (AUDIT-C), are questionnaires used to characterize severity of drinking. We hypothesized that liver injury and short-term outcomes of alcohol-associated hepatitis (AH) would correlate with a patient's recent alcohol consumption as determined by AUDIT-10 and AUDIT-C. We analyzed a prospective international database of patients with AH diagnosed based on the National Institute on Alcohol Abuse and Alcoholism (NIAAA) standard definitions. All patients were interviewed using AUDIT-10. Primary outcomes included the discriminatory ability of the AUDIT-10 and AUDIT-C scores for predicting survival status at 28 and 90 days and severity of liver injury, as measured by Model for End-Stage Liver Disease-sodium (MELD-Na). The relationship between AUDIT scores and survival status was quantified by calculating the area under the curve of the receiver operating characteristic analysis. The relationship between AUDIT scores and MELD-Na was examined using correlation coefficients. In 245 patients (age range 25-75 years; 35% female), we found no correlation between AUDIT-10 or AUDIT-C scores and either 28- or 90-day mortality. Similarly, there was no correlation between AUDIT-10 and AUDIT-C and MELD-Na scores. There was a strong positive correlation between MELD-Na and 28- and 90-day mortality. Additional measures of severity of alcohol use (average grams of alcohol consumed per day, years of drinking, convictions for driving under the influence, and rehabilitation attempts) and psychosocial factors (marriage, paid employment, and level of social support) had no influence on MELD-Na. In patients presenting with AH, AUDIT-10 and AUDIT-C were predictors of neither clinical severity of liver disease nor short-term mortality, suggesting that level of alcohol consumption in the prior year is not key to the presenting features or outcome of AH.
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Affiliation(s)
- Jessica A Musto
- Division of Gastroenterology and Hepatology University of Wisconsin School of Medicine and Public Health Madison WI University of Pittsburgh Medical Center Pittsburgh PA Liver Unit Hospital Universitari Vall d'HebronUniversitat Autònoma de Barcelona Barcelona Spain Centro de Investigación en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD) Barcelona Spain Division of Gastroenterology, Liver Unit University of Alberta Edmonton AB Canada Hospital Universitario, Departamento de Gastroenterología Universidad Autonoma de Nuevo Leon Monterrey Mexico Division of Digestive and Liver DiseasesDepartment of Medicine Columbia College of Physicians and SurgeonsColumbia University Medical Center New York NY Division of Gastroenterology and Hepatology Weill Cornell Medical College New York NY Liver Unit, Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación en Red de Enfermedades Hepáticas y Digestivas (CIBERehd) Barcelona Spain Institute of Liver Studies King's College London School of Medicine at King's College HospitalKing's College Hospital London United Kingdom Service des Maladies de L'appareil Digestif et Unité INSERM Hôpital Huriez Lille France Section of Digestive Diseases Yale University School of Medicine New Haven CT Section of Digestive Diseases VA-CT Healthcare System West Haven CT UC San Diego San Diego CA
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13
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Anderson MS, Valbuena VSM, Brown CS, Waits SA, Sonnenday CJ, Englesbe M, Mellinger JL. Association of COVID-19 With New Waiting List Registrations and Liver Transplantation for Alcoholic Hepatitis in the United States. JAMA Netw Open 2021; 4:e2131132. [PMID: 34698851 PMCID: PMC8548949 DOI: 10.1001/jamanetworkopen.2021.31132] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
This cross-sectional study examines trends in new waiting list registrations and liver transplantation for alcoholic hepatitis before and during the COVID-19 pandemic in the US.
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Affiliation(s)
- Maia S. Anderson
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - Valeria S. M. Valbuena
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
- National Clinician Scholars Program, University of Michigan, Ann Arbor, Michigan
| | - Craig S. Brown
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - Seth A. Waits
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Christopher J. Sonnenday
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - Michael Englesbe
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Jessica L. Mellinger
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan
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Eriksen LL, Nielsen MA, Laursen TL, Deleuran B, Vilstrup H, Støy S. Early loss of T lymphocyte 4-1BB receptor expression is associated with higher short-term mortality in alcoholic hepatitis. PLoS One 2021; 16:e0255574. [PMID: 34352016 PMCID: PMC8341529 DOI: 10.1371/journal.pone.0255574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 07/19/2021] [Indexed: 12/20/2022] Open
Abstract
Objectives In alcoholic hepatitis (AH), dysfunctional T lymphocytes may contribute to the high mortality from infections. T lymphocyte activation is governed by the expression of co-stimulatory receptors such as 4-1BB balanced by inhibitory receptors such as Programmed Death receptor 1 (PD-1). 4-1BB expression is unaccounted for in AH, while PD-1 is elevated. We characterized expression of 4-1BB and PD-1 and the associated T lymphocyte functional status in AH and investigated whether these were associated with short-term mortality. Methods Thirty-five patients with AH (at diagnosis and days 7 and 90) were compared with healthy controls (HC). Spontaneous and in vitro stimulated receptor expression were quantified by flow cytometry, and plasma proteins by ELISA. Results At diagnosis, the patients showed increased stimulated 4-1BB responses of CD4+ T lymphocytes. Also, the frequencies of PD-1+ T lymphocytes both with and without co-expressed 4-1BB were increased. Further, interferon-gamma was predominantly produced in T lymphocytes co-expressing 4-1BB. A decrease in the frequency of spontaneous 4-1BB+ T lymphocytes and an increase in soluble 4-1BB during the first week after diagnosis were associated with higher mortality at day 90 in AH. PD-1 expression showed no systematic dynamics related to mortality. Conclusions We found an increased stimulated 4-1BB response of T lymphocytes in AH and early loss of these lymphocytes was associated with a higher short-term mortality. This suggests a role of T lymphocyte 4-1BB expression in the progression of AH.
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Affiliation(s)
- Lotte Lindgreen Eriksen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
- * E-mail:
| | | | - Tea Lund Laursen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Bent Deleuran
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Hendrik Vilstrup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Sidsel Støy
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
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15
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Abstract
The natural history of moderate alcoholic hepatitis (AH) is not well known. It is a frequent disease with a probable underestimated incidence compared with its severe form. Among the different prognostic scores predicting short-term mortality in AH, MELD seems to be the most accurate. The mortality of moderate AH is 3% to 7% in the short to medium term and 13% to 20% at 1 year, mainly because of liver-related complications, including severe infections. Long-term abstinence is the main goal of the treatment. There is still need for the development of new therapies for AH, including the less severe forms.
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Affiliation(s)
- Ana Clemente-Sánchez
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh Medical Center (UPMC), BST West 11th Floor, Suite 1116-17, 200 Lothrop Street, Pittsburgh, PA 15213, USA; CIBERehd, Instituto de Salud Carlos III, Avenida Monforte de Lemos, 3-5, Pavilion 11th, Floor 0, Madrid 28029, Spain
| | - Aline Oliveira-Mello
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh Medical Center (UPMC), BST West 11th Floor, Suite 1116-17, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Ramón Bataller
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, Kaufmann Medical Building, 3471 Fifth Avenue, Suite 201.19, Pittsburgh, PA 15213, USA.
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Pinon-Gutierrez R, Durbin-Johnson B, Halsted CH, Medici V. Clinical features of alcoholic hepatitis in latinos and caucasians: A single center experience. World J Gastroenterol 2017; 23:7274-7282. [PMID: 29142474 PMCID: PMC5677196 DOI: 10.3748/wjg.v23.i40.7274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 09/19/2017] [Accepted: 09/26/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To study differences of presentation, management, and prognosis of alcoholic hepatitis in Latinos compared to Caucasians.
METHODS We retrospectively screened 876 charts of Caucasian and Latino patients who were evaluated at University of California Davis Medical Center between 1/1/2002-12/31/2014 with the diagnosis of alcoholic liver disease. We identified and collected data on 137 Caucasians and 64 Latinos who met criteria for alcoholic hepatitis, including chronic history of heavy alcohol use, at least one episode of jaundice with bilirubin ≥ 3.0 or coagulopathy, new onset of liver decompensation or acute liver decompensation in known cirrhosis within 12 wk of last drink.
RESULTS The mean age at presentation of alcoholic hepatitis was not significantly different between Latinos and Caucasians. There was significant lower rate of overall substance abuse in Caucasians compared to Latinos and Latinos had a higher rate of methamphetamine abuse (12.5% vs 0.7%) compared to Caucasians. Latinos had a higher mean number of hospitalizations (5.3 ± 5.6 vs 2.7 ± 2.7, P = 0.001) and mean Emergency Department visits (9.5 ± 10.8 vs 4.5 ± 4.1, P = 0.017) for alcohol related issues and complications compared to Caucasians. There was significantly higher rate of complications of portal hypertension including gastrointestinal bleeding (79.7% vs 45.3%, P < 0.001), spontaneous bacterial peritonitis (26.6% vs 9.5%, P = 0.003), and encephalopathy (81.2% vs 55.5%, P = 0.001) in Latinos compared to Caucasians.
CONCLUSION Latinos have significant higher rates of utilization of acute care services for manifestations alcoholic hepatitis and complications suggesting poor access to outpatient care.
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Affiliation(s)
- Rogelio Pinon-Gutierrez
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of California Davis, Sacramento, CA 95817, United States
| | - Blythe Durbin-Johnson
- Division of Biostatistics University of California Davis, Department of Public Health Sciences, Davis, CA 95616, United States
| | - Charles H Halsted
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of California Davis, Sacramento, CA 95817, United States
| | - Valentina Medici
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of California Davis, Sacramento, CA 95817, United States
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17
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Huang A, Chang B, Sun Y, Lin H, Li B, Teng G, Zou ZS. Disease spectrum of alcoholic liver disease in Beijing 302 Hospital from 2002 to 2013: A large tertiary referral hospital experience from 7422 patients. Medicine (Baltimore) 2017; 96:e6163. [PMID: 28207552 PMCID: PMC5319541 DOI: 10.1097/md.0000000000006163] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Alcohol consumption in China has substantially increased over the last 3 decades and the number of patients with alcoholic liver disease (ALD) is rising at an alarming rate. However, accurate and representative data on time trends in its hospitalization rates are not available. The aim of this study is to assess the current status and burden of ALD in China by analyzing the data from a large tertiary referral hospital, Beijing 302 Hospital.Data were retrospectively recorded from patients diagnosed as ALD in Beijing 302 Hospital from 2002 to 2013. The disease spectrum and biochemical parameters of each patient were collected.The patients with ALD accounted for 3.93% (7422) of all patients (188,902) with liver diseases between 2002 and 2013. The number of patients hospitalized with ALD increased from 110 in 2002 to 1672 in 2013. The ratio of patients hospitalized with ALD to all patients hospitalized with liver diseases was rising almost continuously and increased from 1.68% in 2002 to 4.59% in 2013. Most patients with ALD were male. Age distribution of ALD hospitalization showed that the highest rate was in 40- to 49-year-old group in subjects. Notably, the annual proportion of severe alcoholic hepatitis (SAH) increased 2.43 times from 2002 to 2013. We found the highest levels of mean corpuscular volume, the aspartate aminotransferase/alanine aminotransferase ratio, total bilirubin, international normalized ratio, and alkaline phosphatase in SAH patients, while serum levels of hemoglobin, albumin, and cholinesterase were significantly decreased in SAH group. Among these ALD, the SAH patient population has the worst prognosis. Alcoholic cirrhosis (ALC) is the most common ALD, and annual admissions for ALC increased significantly during the analyzed period.The number of hospitalized patients with ALD and the annual hospitalization rate of ALD were increasing continuously in Beijing 302 Hospital from 2002 to 2013. More attention should be paid to develop population-based effective strategy to control ALD.
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Affiliation(s)
- Ang Huang
- Center of Noninfectious Liver Diseases, Beijing 302 Hospital
- Institute of Alcoholic Liver Disease, Beijing 302 Hospital, Beijing, China
| | - Binxia Chang
- Center of Noninfectious Liver Diseases, Beijing 302 Hospital
- Institute of Alcoholic Liver Disease, Beijing 302 Hospital, Beijing, China
| | - Yin Sun
- Center of Noninfectious Liver Diseases, Beijing 302 Hospital
- Institute of Alcoholic Liver Disease, Beijing 302 Hospital, Beijing, China
| | - Huiming Lin
- Center of Noninfectious Liver Diseases, Beijing 302 Hospital
- Institute of Alcoholic Liver Disease, Beijing 302 Hospital, Beijing, China
| | - Baosen Li
- Center of Noninfectious Liver Diseases, Beijing 302 Hospital
- Institute of Alcoholic Liver Disease, Beijing 302 Hospital, Beijing, China
| | - Guangju Teng
- Center of Noninfectious Liver Diseases, Beijing 302 Hospital
- Institute of Alcoholic Liver Disease, Beijing 302 Hospital, Beijing, China
| | - Zheng-Sheng Zou
- Center of Noninfectious Liver Diseases, Beijing 302 Hospital
- Institute of Alcoholic Liver Disease, Beijing 302 Hospital, Beijing, China
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18
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Budnevsky AV, Esaulenko IE, Grechkin VI, Romashov BB. [Differential diagnostics of febrile conditions in an emergency care clinic]. Klin Med (Mosk) 2016; 94:445-449. [PMID: 30289662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We undertook the analysis of 157 cases of fever at the stages of polyclinic - admission department - hospital treatment for the purpose of elucidating the structure of febrile syndrome. Pneumonia developed in 45 patients, infectious endocarditis in 34, chronic alcoholic hepatitis in 21, rheumatoid arthritis (pseudoseptic variant) in 2, systemic lupus erythematosus in 1, polymyositis in 2, acute pyelonephritis (exacerbation of chronic pyelonephritis) in 15, tumours of different localization in 37 patients. We evaluated the informative value of some acute-phase blood characteristics obtained, results of X-ray and ultrasonic studies for early diagnostics of pneumonia and infectious endocarditis.
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Abstract
Alcoholic liver disease is one of the most prevalent liver diseases worldwide, and a major cause of morbidity and mortality. Alcoholic hepatitis is a severe form of liver injury in patients with alcohol abuse, can present as an acute on chronic liver failure associated with a rapid decline in liver synthetic function, and consequent increase in mortality. Despite therapy, about 30%-50% of patients with severe alcoholic hepatitis eventually die. The pathogenic pathways that lead to the development of alcoholic hepatitis are complex and involve oxidative stress, gut dysbiosis, and dysregulation of the innate and adaptive immune system with injury to the parenchymal cells and activation of hepatic stellate cells. As accepted treatment approaches are currently limited, a better understanding of the pathophysiology would be required to generate new approaches that improve outcomes. This review focuses on recent advances in the diagnosis, pathogenesis of alcoholic hepatitis and novel treatment strategies.
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Affiliation(s)
- Natalie J Torok
- Department of Internal Medicine, UC Davis Medical Center, Sacramento, CA 95817, USA.
- Department of Internal Medicine, Northern California VA System, Mather, CA 95655, USA.
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20
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Damgaard Sandahl T. Alcoholic hepatitis. Dan Med J 2014; 61:B4755. [PMID: 25283626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Alcoholic hepatitis (AH) is an acute inflammatory syndrome causing significant morbidity and mortality. The prognosis is strongly dependent on disease severity, as assessed by clinical scoring systems. Reliable epidemiological data as well as knowledge of the clinical course of AH are essential for planning and resource allocation within the health care system. Likewise, individual evaluation of risk is desirable in the clinical handling of patients with AH as it can guide treatment, improve patient information, and serve as strata in clinical trials. The present PhD thesis is based on three studies using a cohort of nearly 2000 patients diagnosed with AH in Denmark from 1999 to 2008 as a cohort, in a population-based study design. The aims of this thesis were as follows. (1) To describe the incidence and short- and long-term mortality, of AH in Denmark (Study I). (2) To validate and compare the ability of the currently available prognostic scores to predict mortality in AH (Study II). (3) To investigate the short- and long-term causes of death of patients with AH (Study III). During the study decade, the annual incidence rate in the Danish population rose from 37 to 46 per 106 for men and from 24 to 34 per 106 for women. Both short- and long-term mortality rose for men and women, and the increase in short-term mortality was attributable to increasing patient age and prevalence of cirrhosis. Our evaluation of the most commonly used prognostic scores for predicting the mortality of patients with AH showed that all scores performed similarly, with Area under the Receiver Operator Characteristics curves giving values between 0.74 and 0.78 for 28-day mortality assessed on admission. Our study on causes of death showed that in the short-term (< 84 days after diagnosis), patients with AH were likely to die from liver-related events and infections. In the long-term (≥ 84 days after diagnosis), those who developed cirrhosis mainly died from liver-related causes, and those who did not develop cirrhosis mainly died from causes related to alcohol abuse. In conclusion, the present thesis provides novel warranted epidemiological information about AH that shows increasing incidence and mortality rates. Consequently, it reiterates the fact that AH is a life-threatening disease and suggests that AH is an increasing public health concern. The most widely used prognostic models may be helpful adjuvants in the routine management of patients with AH, provided that clinicians are aware of the models' limitations. The causes of death in AH are primarily due to liver-related complications, suggesting that patients with AH could benefit from continued follow-up by a hepatologist after the acute episode.
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Affiliation(s)
- Thomas Damgaard Sandahl
- Department of Hepatology & Gastroenterology V, Aarhus University Hospital, Nørrebrogade 44 building 7, 3rd floor. 8200 Aarhus. Denmark.
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21
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Abstract
Acute liver failure (ALF) is uncommon but fatal. Current management is based mostly on clinical experience. We aimed to investigate the incidence, etiology, outcomes, and prognostic factors of ALF in Taiwan. Patients with the admission diagnosis of ALF between January 2005 and September 2007 were identified from the Longitudinal Health Insurance Database of Taiwan. ALF was further confirmed by disease severity based on laboratory orders, prescriptions, and duration of hospital stay, and acute onset without prior liver disease. Prognostic factors were identified using Cox regression analysis. During the study period, 218 eligible cases were identified from 28,078 potential eligible ALF patients. The incidence was 80.2 per million person-years in average and increased with age. The mean age was 57.9 ± 17.1 years and median survival was 171 days. The most common etiologies were viral (45.4%, mainly hepatitis B virus) and followed by alcohol/toxin (33.0%). Independent prognostic factors included alcohol consumption (hazard ratio, HR, 1.67 [1.01-2.77]), malignancy (HR 2.90 [1.92-4.37]), frequency of checkups per week for total bilirubin (HR 1.57 [1.40-1.76]), sepsis (HR 1.85 [1.20-2.85]), and the use of hemodialysis/hemofiltration (HR 2.12 [1.15-3.9]) and proton pump inhibitor (HR 0.94 [0.90-0.98]). Among the 130 patients who survived ≥90 days, 66 (50.8%) were complicated by liver cirrhosis. Eight (3.7%) were referred for liver transplantation evaluation, but only 1 received transplantation and survived. ALF in Taiwan is mainly due to viral infection. Patients with malignancy and alcohol exposure have worst prognosis. The use of proton pump inhibitor is associated with improved survival. Half of the ALF survivors have liver cirrhosis.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biliary Tract Neoplasms/classification
- Biliary Tract Neoplasms/epidemiology
- Biliary Tract Neoplasms/mortality
- Cause of Death
- Comorbidity
- Cross-Sectional Studies
- Female
- Hepatitis B, Chronic/classification
- Hepatitis B, Chronic/diagnosis
- Hepatitis B, Chronic/epidemiology
- Hepatitis B, Chronic/mortality
- Hepatitis, Alcoholic/classification
- Hepatitis, Alcoholic/diagnosis
- Hepatitis, Alcoholic/epidemiology
- Hepatitis, Alcoholic/mortality
- Humans
- Incidence
- Liver Cirrhosis/classification
- Liver Cirrhosis/diagnosis
- Liver Cirrhosis/epidemiology
- Liver Cirrhosis/mortality
- Liver Failure, Acute/classification
- Liver Failure, Acute/diagnosis
- Liver Failure, Acute/epidemiology
- Liver Failure, Acute/etiology
- Liver Failure, Acute/mortality
- Liver Transplantation/mortality
- Longitudinal Studies
- Male
- Middle Aged
- Prognosis
- Referral and Consultation/statistics & numerical data
- Risk Factors
- Severity of Illness Index
- Survival Analysis
- Taiwan
- Young Adult
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Affiliation(s)
- Cheng-Maw Ho
- Department of Surgery (CMH, PHL, HSL, RHH), Department of Internal Medicine (JYW), National Taiwan University Hospital, Graduate Institute of Clinical Medicine (CMH, PHL, HSL), and Department of Internal Medicine (JYW), College of Medicine, National Taiwan University, Department of Pulmonary Medicine (CHL), Wanfang Hospital, Taipei Medical University, Taipei, Taiwan
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Singal AK, Kamath PS, Gores GJ, Shah VH. Alcoholic hepatitis: current challenges and future directions. Clin Gastroenterol Hepatol 2014; 12:555-64; quiz e31-2. [PMID: 23811249 PMCID: PMC3883924 DOI: 10.1016/j.cgh.2013.06.013] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 06/06/2013] [Accepted: 06/07/2013] [Indexed: 02/07/2023]
Abstract
Alcoholic hepatitis is a distinct clinical syndrome among people with chronic and active alcohol abuse, with a potential for 30%-40% mortality at 1 month among those with severe disease. Corticosteroids or pentoxifylline are the current pharmacologic treatment options, but they provide only about 50% survival benefit. These agents are recommended for patients with modified discriminant function (mDF) ≥ 32 or Model for End-Stage Liver Disease score ≥ 18. The Lille score is used to determine response to steroids. Currently, a minimum of 6 months of abstinence from alcohol use is required for patients to receive a liver transplant, a requirement that cannot be met by patients with severe alcoholic hepatitis nonresponsive to steroids (Lille score ≥ 0.45). Data are emerging on the benefit of liver transplantation in select patients with first episode of severe alcoholic hepatitis. This review also focuses on recent treatment trials in alcoholic hepatitis including liver transplantation and its associated controversies, as well as possible future targets and pharmacologic treatment options for patients with alcoholic hepatitis that are being pursued through upcoming consortium studies.
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Affiliation(s)
- Ashwani K Singal
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Patrick S Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Gregory J Gores
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Vijay H Shah
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
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Gustot T, Moreno C. [Management of alcoholic hepatitis]. Rev Med Brux 2012; 33:212-214. [PMID: 23091923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Alcoholic hepatitis is a severe form of alcoholic liver disease. Diagnosis is based on the association of new onset of jaundice and a compatible liver biopsy. Alcoholic hepatitis is severe when the Maddrey is up to 32 and, in this case, is associated with a mortality of 40-50% at 2 months. Corticosteroids improve survival of patients suffering from severe alcoholic hepatitis. The decrease of total bilirubin at day 7 of treatment and the Lille score are markers of response to corticosteroids. The absence of response is associated with a dramatic outcome (mortality rate of 75% at 6 months). Liver transplantation could be an alternative in a strictly selected group of non-responders.
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Affiliation(s)
- T Gustot
- Service de Gastroentérologie et d'Hépatopancréatologie, Hôpital Erasme et Laboratoire de Gastroentérologie Expérimentale, Faculté de Médecine, ULB, Bruxelles.
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Antar R, Wong P, Ghali P. A meta-analysis of nutritional supplementation for management of hospitalized alcoholic hepatitis. Can J Gastroenterol 2012; 26:463-7. [PMID: 22803023 PMCID: PMC3395449 DOI: 10.1155/2012/945707] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 11/25/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND Alcoholic liver disease (ALD) is associated with a high risk of morbidity and mortality. Malnutrition accompanies this condition and may be both a consequence of and contributor to the pathology. Many trials have investigated the benefits of providing supplemental nutrition in the management of patients with ALD. The present study is a meta-analysis of the available evidence. METHOD A meta-analysis of randomized controlled studies comparing nutritional supplementation plus a normal hospital diet versus diet alone. RESULTS Seven randomized controlled studies including 262 patients with ALD were identified. Pooled analysis revealed no statistical difference in mortality between groups given special nutritional therapy versus a normal balanced diet (OR 0.80 [95% CI 0.42 to 1.52]). In addition, nutrition did not significantly improve ascites (OR 1.29 [95% CI 0.52 to 3.20]) or any biochemical parameters. However, encephalopathy showed a significant improvement or resolution (OR 0.24 [95% CI 0.06 to 0.93]). CONCLUSION Nutritional supplementation provided no mortality benefit in patients with ALD, and neither ascites nor biochemical parameters significantly improved. However, encephalopathy was significantly ameliorated and, therefore, nutritional supplementation should be encouraged in that setting.
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Affiliation(s)
- Ramy Antar
- McGill University Health Centre, Montreal, Quebec
| | - Phil Wong
- McGill University Health Centre, Montreal, Quebec
| | - Peter Ghali
- McGill University Health Centre, Montreal, Quebec
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25
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Sivolap IP. [Alcohol-induced liver injury]. Zh Nevrol Psikhiatr Im S S Korsakova 2011; 111:49-54. [PMID: 22611697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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26
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Abstract
In the period 1970-1984 alcoholic hepatitis was diagnosed by liver biopsy in 52 females. Thirty-six patients with cirrhosis were generally in a worse clinical and biochemical state than those without cirrhosis. Biochemical tests for liver function showed significant improvement from admission to the time of liver biopsy. At follow-up liver function tests were generally better in patients who had stopped drinking alcohol compared to those who continued to do so. The 5-year survival rate was 82% for females without cirrhosis, and 45% for those with cirrhosis (p less than 0.03). Considering the sex-related differences in alcohol abuse in the general population we found no evidence of increased susceptibility to the hepatotoxic effect of alcohol in females.
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Affiliation(s)
- N Milman
- Department of Internal Medicine B, Bispebjerg Hospital, Copenhagen, Denmark
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27
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Abstract
Rising levels of alcohol consumption in the UK are leading to substantial increases in morbidity and mortality from liver disease. Drinking is starting at an earlier age with binging an increasing common pattern, and women are overtaking men in the consumption. Manifestations of liver damage range from fatty liver to end-stage cirrhosis, but it is the increasing number of cases presenting with an acute alcoholic hepatitis (AAH) that are the cause for greatest concern. Development of well-validated prognostic scoring systems (Maddrey Modified Discriminant Function, Glasgow Alcohol Score) makes it possible to select those patients with AAH who are most likely to respond to corticosteroids. The results of early pilot studies of a number of anti-TNF agents are encouraging and with infliximab, reduction in portal pressure has been demonstrated to be consequent on controlling inflammatory processes in the liver. For those deteriorating to the stage of liver failure, artificial liver support with MARS is of value in correcting major pathophysiological disturbances and as a bridge to liver transplantation, the results of which both for end-stage alcoholic cirrhosis and for AAH--of which there is limited experience, are excellent. Even as the stringent regulatory measures needed to control rising alcohol consumption are introduced by government, the burden of liver disease in the UK will remain high for years to come.
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Affiliation(s)
- Roger Williams
- Institute of Hepatology, University College London Medical School, 69-75 Chenies Mews, London, WC1E 6HX, UK.
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28
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Abstract
Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are the hepatic manifestations of the metabolic syndrome. Since the prevalence of obesity and consequently of the metabolic syndrome is steadily increasing, the different types of NAFLD are nowadays the most common cause of liver injury in North America. The development of NASH and fatty liver cirrhosis occurs after a "two-hit-theory", in which hepatic steatosis is followed by lipid peroxidation, the production of cytokines and the induction of Fas ligand. A standardized drug based therapy does not exist so far, but glitazones have emerged as a promising treatment option. However, since the disease is related to Western lifestyle, treatment should be based on prevention and changes in lifestyle.
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Affiliation(s)
- J Wiegand
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Leipzig, Philipp-Rosenthal-Str. 27, 04103 Leipzig, Deutschland
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Chung NS, Kwon OS, Park CH, Kim YN, Cho GH, Lee JJ, Kim GH, Kim HO, Ko KI, Yu SK, Kwon KA, Kim YS, Choi DJ, Kim JH. [A comparative cross-sectional study of the development of hepatocellular carcinoma in patients with liver cirrhosis caused by hepatitis B virus, alcohol, or combination of hepatitis b virus and alcohol]. Korean J Gastroenterol 2007; 49:369-75. [PMID: 17641555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND/AIMS Alcohol may be a cocarcinogen in patients with chronic viral hepatitis. We investigated the effect of alcohol on the development of hepatocellular carcinoma (HCC) in liver cirrhosis (LC) caused by hepatitis B virus (HBV). METHODS All patients with LC or HCC associated with HBV or alcohol, admitted between March 2001 and June 2005, were included. Patients were divided into three groups according to the etiology of LC: Alcohol (AL), HBV, or HBV alcohol (HBV AL). Age and laboratory data at the enrollment of study were analyzed. The logistic regression coefficiency for the prevalence of HCC was calculated by using variables such as age, gender, serologic markers, and etiology of LC. RESULTS In LC patients (n=342), the proportions of AL, HBV, and HBV AL groups were 44%, 39%, and 17%, respectively. The proportions of HCC in AL, HBV and HBV AL groups were 17%, 55%, and 76%, respectively. Age at the diagnosis of HCC was younger in HBV AL than in AL group (p=0.036). In logistic regression analysis for the risk factor of HCC, odds ratio of age was 1.056 (p0.001). Odds ratios of HBV and HBV AL group comparing AL were 8.449 (p0.001) and 17.609 (p0.001), respectively. Therefore, old age and chronic alcohol intake in patients with HBsAg were the risk factors of HCC. CONCLUSIONS Chronic alcohol intake may be an additive factor for the development of HCC in patient with LC caused by HBV. However, a prospective cohort study is needed to confirm these findings.
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Affiliation(s)
- Nak So Chung
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
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30
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Nikushkina IN, Maev IV, Samsonov AA, Andreev NG, Salova LM. [Etiology of chronic diffuse liver damages]. Eksp Klin Gastroenterol 2007:36-164. [PMID: 18389595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Patients with chronic diffuse liver damages have cases of chronic hepatitis associated with alcoholic liver disease being transformed to cirrhosis 2.1 times more often when having mostly equal frequency of chronic damage of viral and alcoholic origin on the stage of chronic hepatitis or in the case of pure viral damage against a background of significant prevalence (3 times) of viral etiology. Infection associated with HCV in patients with alcoholic liver cirrhosis doesn't significantly influence the course of disease, aftereffects and prognosis of patients.
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MESH Headings
- Antibodies, Viral/analysis
- Diagnosis, Differential
- Hepatitis, Alcoholic/diagnosis
- Hepatitis, Alcoholic/epidemiology
- Hepatitis, Alcoholic/etiology
- Hepatitis, Chronic/diagnosis
- Hepatitis, Chronic/epidemiology
- Hepatitis, Chronic/etiology
- Hepatitis, Viral, Human/diagnosis
- Hepatitis, Viral, Human/epidemiology
- Hepatitis, Viral, Human/etiology
- Hepatitis, Viral, Human/virology
- Humans
- Liver Cirrhosis/diagnosis
- Liver Cirrhosis/epidemiology
- Liver Cirrhosis/etiology
- Prevalence
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Abstract
Although there are no liver diseases specific to advanced age, the clinical course and management of liver diseases in the elderly may differ in several aspects from those of younger adults. During the last decade an explosion of new knowledge in liver disease has provoked increasing enthusiasm among hepatologists. On the other hand, the development of new emerging conditions (e.g. non-alcoholic steatohepatitis) and novel therapeutic approaches has made it increasingly difficult to validate and assimilate information to be applied in clinical practice. Some liver diseases in the elderly need to be revisited, particularly non-alcoholic fatty liver disease, chronic hepatitis C, alcoholic liver disease, and hepatocellular carcinoma. Moreover, some therapeutic approaches, especially antiviral therapy and liver transplantation, should be discussed also in selected groups of elderly patients.
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MESH Headings
- Aged
- Aged, 80 and over
- Aging/physiology
- Fatty Liver/diagnosis
- Fatty Liver/epidemiology
- Fatty Liver/therapy
- Female
- Hepatitis C, Chronic/diagnosis
- Hepatitis C, Chronic/epidemiology
- Hepatitis C, Chronic/therapy
- Hepatitis, Alcoholic/diagnosis
- Hepatitis, Alcoholic/epidemiology
- Hepatitis, Alcoholic/therapy
- Humans
- Incidence
- Liver Diseases/diagnosis
- Liver Diseases/epidemiology
- Liver Diseases/therapy
- Liver Diseases, Alcoholic/diagnosis
- Liver Diseases, Alcoholic/epidemiology
- Liver Diseases, Alcoholic/therapy
- Liver Neoplasms/diagnosis
- Liver Neoplasms/epidemiology
- Liver Neoplasms/therapy
- Male
- Prognosis
- Risk Assessment
- Severity of Illness Index
- Survival Rate
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Affiliation(s)
- Annarosa Floreani
- Department of Surgical and Gastroenterological Sciences, University of Padova, Padova, Italy.
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Abstract
Alcoholic hepatitis is a form of hepatic injury that carries a significant morbidity and mortality. The clinical presentation is that of fatigue, malaise, and jaundice in individuals who have abused excessive quantities of alcohol. Severity at presentation, traditionally calculated using the Maddrey Discriminant Function, determines outcome; the short-term mortality can be exceptionally high, with many persons dying within 1 month of hospitalization. This article summarizes the epidemiology, pathogenesis, pathology, and clinical features of alcoholic hepatitis. Prognostic scoring systems and therapeutic options receive special emphasis.
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Affiliation(s)
- David A Sass
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Kaufmann Medical Building, Suite 916, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
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33
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Haas SL, Singer MV. [Alcoholic liver diseases]. Dtsch Med Wochenschr 2005; 130 Suppl 5:S223-5. [PMID: 16435717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
MESH Headings
- Fatty Liver, Alcoholic/complications
- Fatty Liver, Alcoholic/diagnosis
- Fatty Liver, Alcoholic/epidemiology
- Fatty Liver, Alcoholic/therapy
- Germany/epidemiology
- Hepatitis, Alcoholic/complications
- Hepatitis, Alcoholic/diagnosis
- Hepatitis, Alcoholic/epidemiology
- Hepatitis, Alcoholic/therapy
- Humans
- Liver Cirrhosis, Alcoholic/complications
- Liver Cirrhosis, Alcoholic/diagnosis
- Liver Cirrhosis, Alcoholic/epidemiology
- Liver Cirrhosis, Alcoholic/therapy
- Liver Diseases, Alcoholic/complications
- Liver Diseases, Alcoholic/diagnosis
- Liver Diseases, Alcoholic/epidemiology
- Liver Diseases, Alcoholic/therapy
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Affiliation(s)
- S L Haas
- II Medizinische Universitätsklinik, Schwerpunkte: Gastroenterologie, Hepatologie und Infekti-onskrankheiten, Fakultät für Klinische Medizin Mannheim der Universität Heidelberg
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Abstract
First described over 40 years ago, alcoholic hepatitis (AH) (an acute inflammation of the liver) is a common condition seen in 10-35% of heavy drinkers. In its severest form acute AH carries a high short-term mortality of up to 60%. Although the current treatment options are limited, many of the complications associated with increased mortality, such as hepatorenal syndrome, are preventable. The incidence of AH in the UK is set to rise as a result of the increase in heavy drinking. This article aims to increase awareness of the disease aetiology and to review current management strategies and nursing care.
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Affiliation(s)
- Suzanne Sargent
- Institute of Liver Studies, King's College Hospital, Denmark Hill, London
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35
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Abstract
Alcohol is a known hepatotoxic agent, which may exacerbate liver injury caused by other agents. The wide prevalence of alcohol use and abuse in society makes it an important cofactor in many other liver diseases. Examples of liver diseases that are significantly influenced by ingestion of alcohol include chronic viral hepatitis, disorders of iron overload, and obesity-related liver disease.
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MESH Headings
- Comorbidity
- Disease Progression
- Female
- Hepatitis B, Chronic/diagnosis
- Hepatitis B, Chronic/epidemiology
- Hepatitis C, Chronic/diagnosis
- Hepatitis C, Chronic/epidemiology
- Hepatitis, Alcoholic/diagnosis
- Hepatitis, Alcoholic/epidemiology
- Hepatitis, Viral, Human/diagnosis
- Hepatitis, Viral, Human/epidemiology
- Humans
- Incidence
- Liver Cirrhosis, Alcoholic/diagnosis
- Liver Cirrhosis, Alcoholic/epidemiology
- Liver Function Tests
- Male
- Risk Assessment
- Severity of Illness Index
- United States/epidemiology
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Affiliation(s)
- Sripriya Balasubramanian
- Division of Gastroenterology and Hepatology, University of California at Davis, 4150 V Street #3500, Sacramento, California 95817, USA
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36
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Horie Y, Ishii H, Hibi T. [National survey of alcoholic liver disease in Japan]. Nihon Arukoru Yakubutsu Igakkai Zasshi 2004; 39:505-10. [PMID: 15675363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
BACKGROUND Recently, the incidence of alcoholic liver disease (ALD) has been increasing in Japan in association with increased alcoholic beverage consumption. The objectives of this study were 1) to investigate the incidence of ALD in Japan from 1998 to 2002, and 2) to determine whether hepatitis virus affects its prevalence. METHODS A nation-wide survey of hospitals qualified by the Japanese Society of Gastroenterology was conducted to determine the status of ALD in-patients since 1998. The prevalence of hepatitis virus infection in each kind of ALD patient was also investigated. RESULTS Of all ALD patients, 73% did not have viral hepatitis. Except for the hepatocellular carcinomas (HCC) in heavy drinkers and chronic alcoholic hepatitis types, the percentage of ALD with negative viral hepatitis markers constituted more than 80%. However, the percentage of HCC patients without viral hepatitis was 34% of all heavy drinkers with HCC, and the percentage of chronic alcohol hepatitis patients without viral hepatitis was 24%. The percentage of individuals with viral hepatitis has significantly decreased among the alcoholic liver cirrhosis patients. CONCLUSIONS In conclusion, ethanol intake per se plays an important role in the pathogenesis of ALD, except with the HCC in heavy drinkers and chronic alcoholic hepatitis types. Hepatitis virus continues to play a crucial role in the pathogenesis of HCC in heavy drinkers and chronic alcohol hepatitis, although it is less involved in the pathogenesis of alcoholic liver cirrhosis, which contributes to the pathogenesis of most HCCs.
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Affiliation(s)
- Yoshinori Horie
- Department of Internal Medicine, Eiju General Hospital, 2-23-16 Higashiueno, Taitoh-ku, Tokyo 110-8684, Japan
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37
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Horie Y, Ishii H. [Severe alcoholic hepatitis in Japan]. Nihon Shokakibyo Gakkai Zasshi 2002; 99:1326-33. [PMID: 12462051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Multiple organ failures are frequently observed in patients with severe alcoholic hepatitis. Most of the patients have a poor prognosis similar to fluminant hepatitis. Since alcohol intake has been recently increasing in Japan, severe alcoholic hepatitis is expected to be increased. The objective of this study was to determine whether there was any factor by which prognosis of severe alcoholic hepatitis was determined. We carried out nationwide survey by asking the hospitals that are approved by the Japanese Society of Gastroenterology for current incidence of alcoholic liver disease including severe alcoholic hepatitis. We investigated correlations between various factors including blood laboratory data, presence of other organ failure, and prognosis. White blood cell counts and serum creatinine levels were higher, red blood cell counts were lower and prothrombin time were prolonged in the patients who had died than in the patients who had survived. Prevalence of infection, gastrointestinal bleeding, and disseminated intravascular coagulation was higher in the patients who had died. These results suggest that the patients with markedly elevated white blood cell counts, prolonged prothrombin time, anemia, renal failure, infection, or gastrointestinal bleeding should be treated at an earlier stage with plasma exchange, hemodialysis, and anti-coagulation therapy. Since treatment with corticosteroid hormone may worsen the prognosis of severe alcoholic hepatitis, especially with infection or gastrointestinal bleeding, co-administration of anti-bacterial agents and protective drugs for gastrointestinal tracts should be considered.
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Affiliation(s)
- Yoshinori Horie
- Department of Internal Medicine, School of Medicine, Keio University
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38
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Khazanov AI. [Current problems of viral and alcohol diseases of the liver]. Klin Med (Mosk) 2002; 80:14-9. [PMID: 11980151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
517 cases of acute viral hepatitis (AVH) and 1203 cases of hepatic cirrhosis (HC) have been analysed. In recent 20-28 year the trend to a decline in the role of HBV infection in the origin of both AVH and HC. The least lethality was reported for viral C-cirrhoses. When the sale of heavy drinks was limited by the law, lethality of alcoholic hepatic cirrhosis came down 2.5-fold. Among hepatic cirrhoses, the percentage of alcoholic forms has increased from 35.6% in 1972-1984 to 41.5% in 1996-2000. The worst prognosis is now stated for alcoholic-viral and polyviral hepatic cirrhoses. The data for 4.5 years evidence for at least 50% lethality in this group.
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Serov VV. [Does alcoholic chronic hepatitis exist?]. Arkh Patol 1999; 61:54-7. [PMID: 10198708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Alcoholic chronic hepatitis (ACH) can be considered as an independent nosological entity. This conclusion can be made basing on the literature devoted to the mechanisms of ethanol effects on the liver and clinicomorphological features of hepatic ethanol damage. ACH should be included into the new 1994 International classification of chronic hepatitis. Special attention is paid to a higher incidence of combined liver damage induced by alcohol and hepatotropic viruses, especially by hepatitis C virus. Combined virus-alcoholic liver damage will become, in the author's opinion, one of the most important hepatology problems in the coming millenium.
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Affiliation(s)
- V V Serov
- I. M. Sechenov Moscow Medical Academy
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Abstract
BACKGROUND No data have so far been published concerning the extent of the problem of alcohol-related liver diseases in The Netherlands. METHODS Figures on alcohol consumption and admission and mortality rates due to alcohol-related liver disorders in The Netherlands in 1994 were obtained from various sources and the data were considered in a historical perspective. Special attention was paid to regional differences. RESULTS The per capita alcohol consumption in 1994 in The Netherlands was 86 litres of beer, 16 litres of wine and 1.8 litres of pure alcohol as spirits. The total alcohol per capita consumption of individuals upwards of 15 years of age showed a decrease from 11.7 litres in 1975 to 9.7 litres in 1994. In the same period the estimated number consuming more than 10 cl pure alcohol (8 units) per day remained at about 180,000. The number of general hospital admissions as a result of alcohol-related liver disease as well as the number of deaths because of cirrhosis has hardly changed since 1985. In 1994, 657 men and 407 women were admitted due to alcohol-related liver disease, and 269 men and 125 women died from an alcohol-related liver disorder. The admission and mortality rates from alcohol-related liver disease differed markedly among the various provinces of The Netherlands.
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MESH Headings
- Adult
- Age Distribution
- Aged
- Aged, 80 and over
- Alcohol Drinking/adverse effects
- Alcohol Drinking/epidemiology
- Fatty Liver, Alcoholic/epidemiology
- Fatty Liver, Alcoholic/etiology
- Female
- Hepatitis, Alcoholic/epidemiology
- Hepatitis, Alcoholic/etiology
- Humans
- Liver Cirrhosis, Alcoholic/epidemiology
- Liver Cirrhosis, Alcoholic/etiology
- Liver Diseases, Alcoholic/epidemiology
- Liver Diseases, Alcoholic/etiology
- Liver Diseases, Alcoholic/mortality
- Male
- Middle Aged
- Netherlands/epidemiology
- Sex Distribution
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Affiliation(s)
- R P Adang
- Dept. of Gastroenterology and Hepatology, University Hospital Maastricht, The Netherlands
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Curciarello J, Apraiz M, Chiera A, Castelletto R, Vassia MA, Barbero R, Belloni P, Castelletto E, Jmelnitzky A. [Hepatitis B and C virus in chronic alcoholic patients: prevalence and influence on liver injury]. Acta Gastroenterol Latinoam 1997; 26:211-4. [PMID: 9335923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The aim of this prospectively designed study is to analyse the prevalence of HBV and HCV infections in 115 chronic alcohol abusers, their relation to epidemiological variables, and their meaning in pathogenesis and severity of alcoholic liver injury. A prevalence of 13.9% anti-HBc and 20.0% anti-HCV reactivity (EIA II) were found, significantly higher that found in blood donors (3.75 and 0.65% respectively). It is striking our finding of 69.6% "sporadic" type of HCV infection. Histological diagnostic of chronic hepatitis was done in 3 cases, all of them reactive to anti-HCV, enhancing the ethiologic role of HCV in the so called "alcoholic chronic hepatitis". No differences in histological final diagnosis were found related to HBV and HCV markers reactivity, suggesting no clear influence of viral infections on the severity of liver damage in alcoholics in our series. Neither anti-HCV positivity ratio seemed have to influence on these results. Despite a high prevalence of HBV and HCV infection in chronic alcohol abusers, our finding suggest no clear role for them in histological damage.
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Ternák G, Uj M, Szücs G, Bali I, Almási I, Kócsi J. [Serologic signs of Epstein Barr virus activity in acute viral hepatitis, symptomless HbsAg carriers as well as in alcoholic liver diseases]. Orv Hetil 1996; 137:851-5. [PMID: 8657412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The authors, based on their previous observations, analysed the serological incidence of the EBV infection in patients with viral hepatitis, HBsAg carriers and alcoholic liver diseases compared to control group. For the better statistical comparison they have selected the patients of 20-60 years of age and by using Khi-square probe, compared the incidence of IgM and IgG type antibodies against EBV in the samples. Significantly higher incidence (P < 0.05) of IgM antibodies were found in the samples of patients with alcoholic liver disease and of HBsAg carriers compared to the patients of viral hepatitis and control group. No similar distribution was observed related to the IgG type antibodies. Certain degree of "immunocompromised" condition is suspected in the cases of patients with HBsAg carrier state and with alcoholic liver disease known from the literature as the main reason behind the relatively more frequent Epstein-Barr virus infection.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Carrier State
- Female
- Hepatitis B Surface Antigens/immunology
- Hepatitis, Alcoholic/epidemiology
- Hepatitis, Alcoholic/immunology
- Hepatitis, Alcoholic/virology
- Hepatitis, Viral, Human/epidemiology
- Hepatitis, Viral, Human/immunology
- Hepatitis, Viral, Human/virology
- Herpesvirus 4, Human/immunology
- Herpesvirus 4, Human/isolation & purification
- Humans
- Hungary/epidemiology
- Immunoglobulin G/immunology
- Immunoglobulin M/immunology
- Male
- Middle Aged
- Seroepidemiologic Studies
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Affiliation(s)
- G Ternák
- Tolna Megyei Onkormányzat Kórháza, Infektológiai Osztály, Szekszárd
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Rosman AS, Waraich A, Galvin K, Casiano J, Paronetto F, Lieber CS. Alcoholism is associated with hepatitis C but not hepatitis B in an urban population. Am J Gastroenterol 1996; 91:498-505. [PMID: 8633498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Previous studies have suggested an association of viral hepatitis with alcoholism, although the role of confounding risk factors (e.g. i.v. drug use) has not been adequately excluded. We therefore compared the seroprevalences of hepatitis B and C in alcoholic patients to that of a nonalcoholic control group. METHODS Hepatitis B surface antigen, hepatitis B core antibody, hepatitis B surface antibody, and hepatitis C virus antibody testing (second generation ELISA and a confirmatory recombinant immunoblot assay) was performed in 150 consecutive alcoholics admitted for detoxification and in 166 randomly selected patients attending a general medical clinic who were screened for alcoholism. RESULTS Hepatitis B and C seropositivities in actively drinking alcoholics are 49.3 and 35.3%, respectively, and were significantly associated with a history of i.v. drug abuse. Out of 166 general medicine clinics patients, 93 were classified as nonalcoholic (by both self-report and collateral verification), 46 patients had a history of alcoholism , and 27 were indeterminate. In the subgroup of patients without known viral hepatitis risk factors, there was no significant difference in hepatitis B seropositivity among nonalcoholic general medicine clinic patients, alcoholic general medicine clinic patients, and alcoholic patients admitted for detoxification (22.1%, 30.3%, and 27.6%, respectively). In contrast, anti-HCV recombinant immunoblot assay seropositivity in alcohol patients admitted for detoxification without risk factors was significantly greater than in nonalcoholic general medicine patients without risk factors (10 vs 0%, p >0.01). Stepwise logistic regression analysis revealed that alcoholism requiring detoxification was a significant risk factor for hepatitis C but not for hepatitis B seropositivity. CONCLUSIONS The increased seroprevalence of hepatitis C in actively drinking alcoholic patients without known risk factors suggests that alcoholism, in some way, is a predisposing factor for HCV infection.
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Affiliation(s)
- A S Rosman
- Alcohol Research and Treatment Center, Section of Liver Disease and Nutrition, Bronx VA Medical Center, Bronx, New York, USA
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Giusti G, Sagnelli E, Gallo C, Piccinino F, Galanti B, Gaeta GB. The etiology of chronic hepatitis in Italy: a multicenter study. Hepatogastroenterology 1994; 41:397-400. [PMID: 7959581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In a multicenter retrospective study, we reviewed the etiology of chronic hepatitis (CH) in Italy during the period 1980-1989, before the laboratory diagnosis of HCV hepatitis had become possible. Among the 5,461 patients investigated, 31.3% had HBV-CH, 5.5% HDV-CH, 3.0% serological markers of autoimmune hepatitis and 3.7% post-transfusion NANB CH. Alcohol abuse was considered responsible in 10.9% of the cases and a diagnosis of crytogenic CH was made in 42.5%. Considering that most cryptogenic cases were actually due to chronic HCV infection, we may assume that as many as two-thirds of our cases were due to a hepatitis virus infection. Some differences were observed between patients with chronic hepatitis of different etiologies. Drug abuse was frequently recorded only in HDV-CH; patients with HBV-CH and HCV-CH were younger than those in other etiological groups; a histological picture of chronic active hepatitis was more frequently recorded in HDV-CH and autoimmune CH. The only identifiable geographical differences observed were a higher prevalence of HDV-CH in the south and of alcoholic chronic liver diseases in the north. During the period under observation, we noted a clear reduction in the percentages of HBV chronic hepatitis cases after 1984 and, accordingly, the mean age of HBV-CH progressively increased from 1980 to 1989 by almost a year each year. This observation is in agreement with recent data suggesting a reduction in HBV endemicity in Italy in recent years.
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Affiliation(s)
- G Giusti
- Clinic of Infectious Diseases, School of Medicine, Second University of Naples, Italy
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Gubbins GP, Moritz TE, Marsano LS, Talwalkar R, McClain CJ, Mendenhall CL. Helicobacter pylori is a risk factor for hepatic encephalopathy in acute alcoholic hepatitis: the ammonia hypothesis revisited. The Veterans Administration Cooperative Study Group No. 275. Am J Gastroenterol 1993; 88:1906-10. [PMID: 8237940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine whether infection with Helicobacter pylori is a risk factor for portosystemic encephalopathy in patients with acute, moderate or severe alcoholic hepatitis. DESIGN Prospective, multicenter cohort study. SETTING Eight Veterans Affairs Hospitals. PATIENTS A cohort of 273 male patients enrolled in a Department of Veterans Affairs Cooperative Study performed to evaluate the efficacy of oxandrolone in combination with nutritional supplementation in moderate or severe alcoholic hepatitis. MEASUREMENTS Admission serum IgG antibody titers against H. pylori by a specific and sensitive ELISA, demographic characteristics of patients, degree of protein calorie malnutrition, presence of ascites, bilirubin level, and known risk factors for hepatic encephalopathy (gastrointestinal bleeding, azotemia, hepatorenal syndrome, infection, and severity of disease); outcome was the presence of portosystemic encephalopathy. RESULTS Of 188 patients with decompensated alcoholic hepatitis available for analysis, 117 (62.2%) had encephalopathy. Ninety-two (78.6%) of these were infected with H. pylori, compared with 62% of patients without encephalopathy (p = 0.013). In a step-wise regression model, H. pylori was an independent risk factor (relative risk: 2.4, 95% CI: 1.2-4.8) adjusting for ascites and protein-calorie malnutrition. CONCLUSIONS Patients with acute, moderate or severe alcoholic hepatitis have a high H. pylori infection rate (as determined by serology), and those infected are at higher risk for portosystemic encephalopathy.
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Affiliation(s)
- G P Gubbins
- Department of Medicine, University of Kentucky, Lexington
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Lacet CM, Strauss E. [The hepatitis B virus in alcoholic liver disease: its clinical and biochemical assessment]. Rev Soc Bras Med Trop 1993; 26:201-9. [PMID: 8159819 DOI: 10.1590/s0037-86821993000400001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The aim of our work was to study the prevalence of HBV markers in Alcoholic Liver Disease (ALD) by evaluating clinical and biochemical parameters that could further characterize the association. A prospective and sequential study of 107 patients with ALD was performed, including 83 cases of cirrhosis and 24 cases of alcoholic hepatitis. Daily ingestion of pure ethanol was of at least 70 gm for seven years or more and always associated with hepatocellular disfunction. According to the serological profile for HBV markers the patients were allocated to one of four groups: group I infected (positivity of HBsAg and anti-HBc); group II immunized (positivity of anti-HBs and anti-HBc); group III without HBV markers (negativity of HBsAg, anti-HBc and anti-HBs); group IV isolated anti-HBc. The prevalence of HBsAg positivity in ALD was high: 15.89% whereas immunity was low: 26.17% suggesting a great exposure to the virus and a deficient immunological response. No significant statistical differences were found among the three groups when clinical and biochemical parameters were individually considered. Nevertheless, when a Child/Campbell classification was applied, patients with ALD associated with HBV (group I) showed a significant difference, presenting a predominance of child C, with a bad prognosis.
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Affiliation(s)
- C M Lacet
- Clínica de Gastroenterologia, Hospital Heliópolis, SP, Brasil
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Abstract
The characteristics of alcoholic liver disease (ALD) in Japanese patients were reviewed and compared with those in Western countries. From the study in Japanese cases, it became clear that alcoholic fibrosis and chronic hepatitis induced by alcohol were types of ALD other than the traditional 3 types. Liver injury in Japanese cases was clearly milder than that in American cases. In American cases, the injury may be fully developed, because of greater alcohol and fat intake. This may be one reason why the two above types of ALD have not been mentioned in the literature of Western countries. In Japanese patients, hepatitis C virus (HCV) infection is not related to alcoholic fibrosis and alcoholic hepatitis. On the other hand, the prevalence of HCV markers was high in chronic hepatitis, cirrhosis and hepatocellular carcinoma (HCC) patients. Alcoholic hepatitis and chronic hepatitis are the high risk groups for the development of cirrhosis and the chronic hepatitis group is at high risk for the development of HCC. Although the risk is low in alcoholic fibrosis, some patients also develop cirrhosis. About half of the cases of cirrhosis may develop from alcoholic hepatitis and alcoholic fibrosis, and the remaining half cases may develop from chronic hepatitis. Over 80% of HCC cases may develop from chronic hepatitis in Japan. Chronic alcoholism enhanced the development of HCV-related HCC. Recent increase of HCC in alcoholic cirrhosis in Japan may be related to the increase of alcohol consumption, the increase of blood transfusions, and longer survival of cirrhosis patients.
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Affiliation(s)
- A Takada
- Division of Gastroenterology, Department of Internal Medicine, Kanazawa Medical University, Ishikawa Japan
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Corrao G, Arico S, Russo R, Carle F, Galatola G, Torchio PF, Moiraghi AR, di Orio F, de la Pierre M. Alcohol consumption and non-cirrhotic chronic hepatitis: a case-control study. Int J Epidemiol 1991; 20:1037-42. [PMID: 1800401 DOI: 10.1093/ije/20.4.1037] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
We carried out a hospital-based case-control study to assess the association of both the daily amount and the duration of alcohol intake with the risk of developing non-cirrhotic chronic liver disease (chronic hepatitis) in 121 chronic hepatitis patients diagnosed by laparoscopy and liver biopsy, and in 242 matched 'controls' randomly selected from inpatients of the same hospital. Alcohol intake was quantified in all subjects using a standardized questionnaire administered by two doctors unaware of the aim of the study. The odds ratio (OR) for chronic hepatitis was estimated by conditional logistic regression and increased exponentially from 1.0 for non-drinkers to 11.4 for daily alcohol intake of 325 g or more. Considering duration of alcohol consumption from up to 10 to up to 30 years, the ORs for chronic hepatitis consistently decreased for the daily alcohol intake categories of 25-50 g (from 74.1 to 0.7 respectively), 75-100 g (from 149.7 to 0.7 respectively) and 125 g or more (from 212.0 to 1.8 respectively). Our results suggest the existence of a dose-dependent individual susceptibility to the damaging effect of alcohol on the liver.
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Affiliation(s)
- G Corrao
- Department of Internal Medicine and Public Health, University of L'Aquila, Italy
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Furube M, Sugimoto M, Asakura I, Mizukami H, Akita H, Hatori T, Abei T, Sasaki K. [Sex difference in alcoholic liver disease: with special reference to the severity of alcoholic hepatitis]. Arukoru Kenkyuto Yakubutsu Ison 1989; 24:135-43. [PMID: 2803107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Purpose of this study was to elucidate the difference in severity of alcoholic liver diseases (ALD), especially of alcoholic hepatitis (AH) between female and male. We have experienced 15 female and 113 male patients with ALD laparoscopically and histologically proved during the past 10 years. In female patients, histological analysis revealed 8 cases of cirrhosis, 2 each cases of AH, fibrosis and chronic hepatitis, and 1 case of fatty liver. Occurrence of AH in female (13%) was significantly higher than male in which AH was seen in 3 cases (3%) (p less than 0.05). Duration of alcoholic abuse in female AH patients was shorter than male AH patients (5.5 +/- 0.5 years vs 24.0 +/- 2.9 years). Total alcohol consumed in female AH patients was less than male AH patients (256 +/- 52 kg vs 1560 +/- 703 kg). Abnormality in liver function tests including hepaplastin test, serum bilirubin, transaminases, lactate dehydrogenase, alkaline phosphatase, gamma-glutamyltranspeptidase, immunoglobulins was outstanding in female patients compared with male patients. Histological findings such as hepatocellular ballooning, neutrophilic infiltration, fatty change and wiremesh fibrosis were intensive in female patients compared with male patients. In conclusion, there were much more severe ALD like AH or cirrhosis in female than male patients. In female AH patients duration of alcoholic abuse was shorter and total alcohol consumed was less than male AH patients. And it was suggested that female AH is clinically and pathologically getting severe compared with male AH.
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Bell H. [Alcoholic liver disease]. Tidsskr Nor Laegeforen 1988; 108:1768-72. [PMID: 3420581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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