Itzel Timo, Falconer Thomas, Roig Ana, Daza Jimmy, Park Jimyung, Cheong Jae Youn, Park Rae Woong, Wiest Isabella, Ebert Matthias P, Hripcsak George, Teufel Andreas
Division of Hepatology, Division of Bioinformatics, Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Clinical Cooperation Unit Healthy Metabolism, Center for Preventive Medicine and Digital Health Baden-Württemberg (CPDBW), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Dig Dis. 2023;41(5):780-788. doi: 10.1159/000529914. Epub 2023 Jun 26.
Alcoholic liver disease (ALD) is still increasing and leads to acute liver injury but also liver cirrhosis and subsequent complications such as liver failure or hepatocellular carcinoma (HCC). As most patients fail to achieve alcohol abstinence, it is essential to identify alternative treatment options in order to improve the outcome of ALD patients.
Evaluating two large cohorts of patients with ALD from the USA and Korea with a total of 12,006 patients, we investigated the effect on survival of aspirin, metformin, metoprolol, dopamine, and dobutamine drugs in patients with ALD between 2000 and 2020. Patient data were obtained through the "The Observational Health Data Sciences and Informatics consortium," an open-source, multi-stakeholder, and interdisciplinary collaborative effort.
The use of aspirin (p = 0.000, p = 0.000), metoprolol (p = 0.002, p = 0.000), and metformin (p = 0.000, p = 0.000) confers a survival benefit for both AUSOM- and NY-treated cohorts. Need of catecholamines dobutamine (p = 0.000, p = 0.000) and dopamine (p = 0.000, p = 0.000) was strongly indicative of poor survival. β-Blocker treatment with metoprolol (p = 0.128, p = 0.196) or carvedilol (p = 0.520, p = 0.679) was not shown to be protective in any of the female subgroups.
Overall, our data fill a large gap in long-term, real-world data on patients with ALD, confirming an impact of metformin, acetylsalicylic acid, and β-blockers on ALD patient's survival. However, gender and ethnic background lead to diverse efficacy in those patients.
酒精性肝病（ALD）的发病率仍在上升，可导致急性肝损伤，还会引发肝硬化及后续并发症，如肝衰竭或肝细胞癌（HCC）。由于大多数患者无法戒酒，因此必须确定其他治疗方案以改善ALD患者的预后。
我们评估了来自美国和韩国的两个大型ALD患者队列，共计12006例患者，调查了2000年至2020年间阿司匹林、二甲双胍、美托洛尔、多巴胺和多巴酚丁胺药物对ALD患者生存的影响。患者数据通过“观察性健康数据科学与信息联盟”获得，这是一项开源、多利益相关方和跨学科的合作项目。
使用阿司匹林（p = 0.000，p = 0.000）、美托洛尔（p = 0.002，p = 0.000）和二甲双胍（p = 0.000，p = 0.000）对AUSOM队列和纽约队列的患者均有生存益处。需要使用儿茶酚胺类药物多巴酚丁胺（p = 0.000，p = 0.000）和多巴胺（p = 0.000，p = 0.000）强烈提示生存预后不良。在任何女性亚组中，美托洛尔（p = 0.128，p = 0.196）或卡维地洛（p = 0.520，p = 0.679）的β受体阻滞剂治疗均未显示出保护作用。
总体而言，我们的数据填补了ALD患者长期真实世界数据的巨大空白，证实了二甲双胍、乙酰水杨酸和β受体阻滞剂对ALD患者生存的影响。然而，性别和种族背景导致这些患者的疗效存在差异。
