Department of Medicine, Brighton and Sussex Medical School, Brighton, UK.
Aliment Pharmacol Ther. 2013 Sep;38(6):584-95. doi: 10.1111/apt.12427. Epub 2013 Jul 23.
Although short-term outcome in severe alcoholic hepatitis (SAH) is well described, its long-term course remains uncharacterised.
To assess determinants of long-term outcome in SAH.
Data were recorded from a cohort with SAH (admission Discriminant Function (DF) ≥32). Kaplan-Meier (KM) and Cox proportional hazards survival analyses were performed to determine predictors of outcome.
One hundred and nine patients were included; 63.3% male, aged 49.6 ± 9.4 years with median follow-up of 40.7 months (95% CI 37.2-44.3). Median DF was 58, 86.2% had cirrhosis and 65.1% received corticosteroids and/or pentoxifylline. Overall mortality was 57.8%, 96.8% of deaths being liver-related and 65.1% occurring after the index hospitalisation. Estimated 5-year survival was 31.8%. Hepatorenal syndrome was the only baseline factor independently associated with mortality (HR 3.78, 95% CI 1.98-7.19, P < 0.0001), although it predicted short-term, rather than long-term outcome (median survival 0.52 months, 95% CI 0.43-0.61). Of the 87 patients (79.8%) who survived index hospitalisation, 65.1% experienced recidivism. Abstinence at last follow-up remained the only independent predictor of survival in multivariate analysis (HR 0.370, 95% CI 0.168-0.818, P = 0.014). Five-year survival was higher in abstainers (75.3%) compared with relapsed and continued drinkers (26.8% and 21.0%, respectively, P = 0.005). However, the survival benefit from abstinence only became statistically significant at 18 months postdischarge (HR 2.714, 95% CI 0.995-7.404, P = 0.051).
Estimated 5-year survival after index hospitalisation with SAH is 31.8% with alcohol relapse occurring in two-thirds of patients. Abstinence remains the only independent predictor of long-term survival. Novel strategies to improve abstinence after admission with SAH are urgently needed.
尽管重症酒精性肝炎（SAH）的短期预后已有很好的描述，但长期预后仍未明确。
评估 SAH 长期预后的决定因素。
从 SAH 队列（入院判别函数（DF）≥32）中记录数据。采用 Kaplan-Meier（KM）和 Cox 比例风险生存分析来确定预后的预测因素。
共纳入 109 例患者；男性占 63.3%，年龄 49.6±9.4 岁，中位随访时间为 40.7 个月（95%CI 37.2-44.3）。中位 DF 为 58，86.2%有肝硬化，65.1%接受皮质类固醇和/或己酮可可碱治疗。总死亡率为 57.8%，96.8%的死亡与肝脏相关，65.1%发生在指数住院后。估计 5 年生存率为 31.8%。肝肾综合征是唯一与死亡率独立相关的基线因素（HR 3.78，95%CI 1.98-7.19，P<0.0001），尽管它预测的是短期而非长期预后（中位生存时间 0.52 个月，95%CI 0.43-0.61）。在指数住院存活的 87 例患者（79.8%）中，65.1%复发。最后一次随访时的戒酒仍然是多变量分析中生存的唯一独立预测因素（HR 0.370，95%CI 0.168-0.818，P=0.014）。与复发和继续饮酒者相比，戒酒者的 5 年生存率更高（分别为 75.3%、26.8%和 21.0%，P=0.005）。然而，只有在出院后 18 个月时，戒酒的生存获益才具有统计学意义（HR 2.714，95%CI 0.995-7.404，P=0.051）。
SAH 指数住院后估计 5 年生存率为 31.8%，三分之二的患者会出现酒精复发。戒酒仍然是长期生存的唯一独立预测因素。迫切需要新的策略来提高 SAH 入院后的戒酒率。
