Department of Internal Medicine, Division of Gastroenterology, Center for Aging, University of Texas Medical Branch, Galveston, USA.
Eur J Gastroenterol Hepatol. 2011 Mar;23(3):204-9. doi: 10.1097/MEG.0b013e328343b085.
Limited information is available on the impact of hepatitis C virus (HCV) infection on the clinical course and outcome of acute alcoholic hepatitis (AH), a condition with a significant mortality. We designed this retrospective study to assess effect of HCV on the outcome of patients with AH.
Medical charts of patients with a discharge diagnosis of AH (defined using rigorous clinical criteria) were reviewed. Patients were stratified based on the presence or absence of concomitant HCV infection. The disease severity was estimated at admission and at day 7 using model for end-stage disease and discriminant function index scores. Patient survival at 6 months was confirmed with the county death registry.
A total of 76 (29 HCV positive) AH cases were analyzed. At admission, disease severity was similar in both groups with severe disease in 53% (49% of AH alone and 59% of AH+HCV; P = 0.18). Although severity scores at day 7 were not available for all patients, disease severity tended to be worse for patients with AH+HCV. Kaplan-Meier survival curves showed a poor survival for AH+HCV compared with AH alone (69 vs. 91%; log-rank P = 0.015). Although patients with AH+HCV were treated less often compared with AH alone (27 vs. 54%; P = 0.05), HCV emerged as an independent risk factor for a poor outcome at 6 months (Cox proportional hazard ratio 8.45; P = 0.01) after controlling for patient demographics, disease severity at admission, and treatment.
HCV may be a risk factor for patients with AH with a worse outcome at 6 months. If our findings are confirmed in larger databases, prospective studies are needed to examine mechanisms for this effect of HCV on the outcome of AH.
关于丙型肝炎病毒（HCV）感染对急性酒精性肝炎（AH）临床病程和转归的影响，相关信息有限，AH 是一种死亡率较高的疾病。我们设计了这项回顾性研究，以评估 HCV 对 AH 患者结局的影响。
回顾性分析具有出院诊断 AH（采用严格临床标准定义）的患者的病历。根据是否合并 HCV 感染对患者进行分层。采用终末期肝病模型和判别函数指数评分，于入院时和第 7 天评估疾病严重程度。通过县死亡登记处确认患者 6 个月的生存情况。
共分析了 76 例（29 例 HCV 阳性）AH 病例。两组患者入院时疾病严重程度相似，53%的患者为重症（单纯 AH 患者中为 49%，AH+HCV 患者中为 59%；P = 0.18）。尽管并非所有患者均有第 7 天的严重程度评分，但 AH+HCV 患者的疾病严重程度似乎更差。Kaplan-Meier 生存曲线显示，与单纯 AH 相比，AH+HCV 的生存情况较差（69% vs. 91%；log-rank P = 0.015）。尽管与单纯 AH 相比，AH+HCV 患者接受治疗的频率较低（27% vs. 54%；P = 0.05），但在校正患者人口统计学特征、入院时疾病严重程度和治疗后，HCV 仍是 6 个月预后不良的独立危险因素（Cox 比例风险比 8.45；P = 0.01）。
HCV 可能是 AH 患者 6 个月预后不良的危险因素。如果我们的发现得到更大数据库的证实，需要开展前瞻性研究来探讨 HCV 对 AH 结局影响的机制。
