AP-HP, UPMC, Department of Hepatogastroenterology, La Pitié-Salpêtrière Hospital, 47-80 boulevard de l'Hôpital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie University, 75013 Paris, France.
AP-HP, UPMC, Department of Anatomopathology, La Pitié-Salpêtrière Hospital, 47-80 boulevard de l'Hôpital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie University, 75013 Paris, France.
J Hepatol. 2015 Apr;62(4):816-21. doi: 10.1016/j.jhep.2014.11.003. Epub 2014 Nov 11.
BACKGROUND & AIMS: All trials on severe alcoholic hepatitis (AH) have included patients with "pure" AH, i.e., without concomitant gastrointestinal bleeding (GIB). Severe AH is often suspected in cirrhotic patients with GIB. We aimed at (1) assessing the prevalence of AH in patients with GIB and Maddrey discriminant function (DF) ⩾32; (2) comparing the outcome in AH patients with or without GIB (AH-GIB+, AH-GIB-); and (3) assessing the performance of the Lille model for survival in AH-GIB+ patients.
We retrospectively included all patients with alcoholic cirrhosis admitted between January 2005 and March 2011 with the following: (1) jaundice <3 months; (2) DF ⩾32 at admission; (3) bilirubin level >50 μmol/L; and (4) active drinking. Exclusion criteria were advanced hepatocellular carcinoma, other etiology of cirrhosis, severe comorbidities and DF <32 after stabilization. In our centre, we systematically plan a liver biopsy for these patients. Patients with severe AH received prednisolone.
We screened 161 patients (86 GIB+, 75 GIB-), and analyzed data for 58 and 47 patients in each group, respectively. The 2 groups did not differ in prevalence of AH (77.3% vs. 81%), demographic data, MELD/Child-Pugh score, or DF. The 2 groups were similar in 6-month probability of survival (73.9 ± 6.0% vs. 69.9 ± 7%, p=0.49). The probability of developing infection was lower for AH-GIB+ patients (24.1% vs. 44.7%, p=0.04). The AUC for the Lille model in predicting 6-month survival was 0.71 ± 0.06 for all patients and 0.74 ± 0.06 for AH-GIB+ patients (p>0.05).
Prevalence of AH is 80% for patients with cirrhosis and GIB, recent jaundice and DF ⩾32. Infection was lower for AH-GIB+ patients, which suggests a beneficial role of antibiotic prophylaxis treatment. Survival among subjects with GIB was the same as among subjects without GIB.
所有重症酒精性肝炎（AH）的临床试验都纳入了“单纯”AH 患者，即没有合并胃肠道出血（GIB）的患者。肝硬化合并 GIB 的患者通常会被怀疑患有重症 AH。我们旨在：（1）评估有 GIB 和 Maddrey 判别函数（DF）≥32 的患者中 AH 的发生率；（2）比较有 GIB（AH-GIB+，AH-GIB-）和无 GIB 的 AH 患者的结局；（3）评估 Lille 生存模型在 AH-GIB+患者中的表现。
我们回顾性纳入了 2005 年 1 月至 2011 年 3 月期间因以下原因住院的所有酒精性肝硬化患者：（1）黄疸<3 个月；（2）入院时 DF≥32；（3）胆红素水平>50 μmol/L；（4）持续饮酒。排除标准为晚期肝细胞癌、其他病因所致肝硬化、严重合并症和稳定后 DF<32。在我们中心，我们会为这些患者系统地计划进行肝活检。重症 AH 患者接受泼尼松龙治疗。
我们筛选了 161 例患者（86 例 GIB+，75 例 GIB-），分别对每组 58 例和 47 例患者进行数据分析。两组 AH 发生率（77.3% vs. 81%）、人口统计学数据、MELD/Child-Pugh 评分或 DF 无差异。两组患者 6 个月生存率的概率相似（73.9±6.0% vs. 69.9±7%，p=0.49）。AH-GIB+患者感染的发生率较低（24.1% vs. 44.7%，p=0.04）。Lille 模型预测 6 个月生存率的 AUC 对于所有患者为 0.71±0.06，对于 AH-GIB+患者为 0.74±0.06（p>0.05）。
对于近期黄疸和 DF≥32 的肝硬化合并 GIB 的患者，AH 的发生率为 80%。AH-GIB+患者的感染率较低，这提示抗生素预防治疗可能有获益作用。有 GIB 的患者与无 GIB 的患者的生存率相同。
