Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic of Barcelona, Red de Trastornos Adictivos (RTA), Barcelona, Spain.
Hepatology. 2017 Dec;66(6):1842-1853. doi: 10.1002/hep.29338.
Alcoholic hepatitis (AH) is the most severe form of alcoholic liver disease. Most studies have focused on short-term prognosis, whereas factors associated with long-term survival are largely unknown. The aims of our study were to (1) determine the impact of complete abstinence from alcohol on long-term survival and (2) identify prognostic factors at admission capable of predicting abstinence during long-term follow-up in patients with AH. One hundred forty-two patients with biopsy-proven AH that survived the first episode were included. Demographic, psychiatric, and biochemical variables at admission and drinking status during follow-up were obtained. Cox regression, logistic regression, and classification and regression trees (CART) analyses were used for statistical analysis. Overall mortality was 38% with a median follow-up of 55 months. During follow-up, complete abstinence was reported in 39% and was associated with better long-term survival (hazard ratio, 0.53; P = 0.03). After adjustment for baseline prognostic scoring systems (Model for End-Stage Liver Disease and age, bilirubin, international normalized ratio, creatinine scores), complete abstinence was independently associated with survival (P < 0.05). Age and lack of past alcoholism treatments were independently associated with complete abstinence (P < 0.001 and P = 0.02, respectively) during follow-up. CART analysis generated a simple and practical algorithm based on the combination of past alcoholism treatments and age. Using CART analysis, we stratified 2 subgroups of patients with high (65%) and low (26%-29%) rates of complete abstinence after an episode of AH.
Complete abstinence after an episode of AH positively impacts long-term survival. The combination of 2 variables easily obtained at admission might be useful to predict long-term abstinence after an episode of AH. Strategies aimed at promoting alcohol abstinence in these patients are necessary. (Hepatology 2017;66:1842-1853).
酒精性肝炎（AH）是最严重的酒精性肝病形式。大多数研究都集中在短期预后上，而与长期生存相关的因素在很大程度上尚不清楚。我们的研究目的是：（1）确定完全戒酒对长期生存的影响；（2）确定在 AH 患者的长期随访中，入院时能够预测戒酒的预后因素。共纳入 142 例经活检证实的首次发作后存活的 AH 患者。获得了入院时的人口统计学、精神病学和生化变量以及随访期间的饮酒状况。使用 Cox 回归、逻辑回归和分类回归树（CART）分析进行统计分析。总死亡率为 38%，中位随访时间为 55 个月。在随访期间，39%的患者报告完全戒酒，且与长期生存相关（危险比，0.53；P=0.03）。在调整基线预后评分系统（终末期肝病模型和年龄、胆红素、国际标准化比值、肌酐评分）后，完全戒酒与生存相关（P<0.05）。年龄和缺乏过去的酒精治疗与随访期间的完全戒酒独立相关（P<0.001 和 P=0.02）。CART 分析基于过去的酒精治疗和年龄的组合生成了一个简单实用的算法。使用 CART 分析，我们根据 AH 发作后完全戒酒的高（65%）和低（26%-29%）率将患者分为 2 个亚组。
AH 发作后完全戒酒对长期生存有积极影响。入院时容易获得的 2 个变量的组合可能有助于预测 AH 发作后的长期戒酒。有必要针对这些患者制定促进戒酒的策略。（Hepatology 2017;66:1842-1853）。
