前一年的饮酒量并不影响酒精性肝炎患者的临床预后。
The Level of Alcohol Consumption in the Prior Year Does Not Impact Clinical Outcomes in Patients With Alcohol-Associated Hepatitis.
机构信息
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.
出版信息
Liver Transpl. 2021 Oct;27(10):1382-1391. doi: 10.1002/lt.26203. Epub 2021 Jul 31.
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.
10 项酒精使用障碍识别测试(AUDIT-10)及其更简短的形式 AUDIT-Consumption(AUDIT-C)是用于描述饮酒严重程度的问卷。我们假设,肝损伤和酒精相关性肝炎(AH)的短期预后与患者最近的饮酒量有关,而这可以通过 AUDIT-10 和 AUDIT-C 来确定。我们分析了一个基于国家酒精滥用和酒精中毒研究所(NIAAA)标准定义诊断为 AH 的患者的前瞻性国际数据库。所有患者均接受 AUDIT-10 访谈。主要结局包括 AUDIT-10 和 AUDIT-C 评分预测 28 天和 90 天生存状态的判别能力,以及通过终末期肝病模型钠(MELD-Na)测量的肝损伤严重程度。通过计算接收者操作特征分析的曲线下面积来量化 AUDIT 评分与生存状态的关系。使用相关系数检查 AUDIT 评分与 MELD-Na 的关系。在 245 例(年龄 25-75 岁;35%为女性)患者中,我们发现 AUDIT-10 或 AUDIT-C 评分与 28 天或 90 天死亡率均无相关性。同样,AUDIT-10 和 AUDIT-C 与 MELD-Na 评分也无相关性。MELD-Na 与 28 天和 90 天死亡率呈强正相关。酒精使用严重程度的其他指标(每天消耗的酒精量、饮酒年限、酒后驾车定罪和康复尝试)和社会心理因素(婚姻、有薪就业和社会支持水平)对 MELD-Na 没有影响。在出现 AH 的患者中,AUDIT-10 和 AUDIT-C 既不能预测肝病的临床严重程度,也不能预测短期死亡率,这表明前一年的饮酒量不是 AH 患者的主要特征或预后的关键因素。