Department of Liver Diseases, Hospital Clínic de Barcelona, Barcelona, Spain.
Liver, Digestive System and Metabolism Department Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.
Hepatology. 2024 Sep 1;80(3):621-632. doi: 10.1097/HEP.0000000000000825. Epub 2024 Mar 5.
Alcohol relapse after surviving an episode of alcohol-associated hepatitis (AH) is common. However, the clinical features, risk factors, and prognostic implications of recurrent alcohol-associated hepatitis (RAH) are not well described.
A registry-based study was done of patients admitted to 28 Spanish hospitals for an episode of AH between 2014 and 2021. Baseline demographics and laboratory variables were collected. Risk factors for RAH were investigated using Cox regression analysis. We analyzed the severity of the index episodes of AH and compared it to that of RAH. Long-term survival was assessed by Kaplan-Meier curves and log-rank tests. A total of 1118 patients were included in the analysis, 125 (11%) of whom developed RAH during follow-up (median: 17 [7-36] months). The incidence of RAH in patients resuming alcohol use was 22%. The median time to recurrence was 14 (8-29) months. Patients with RAH had more psychiatric comorbidities. Risk factors for developing RAH included age <50 years, alcohol use >10 U/d, and history of liver decompensation. RAH was clinically more severe compared to the first AH (higher MELD, more frequent ACLF, and HE). Moreover, alcohol abstinence during follow-up was less common after RAH (18% vs. 45%, p <0.001). Most importantly, long-term mortality was higher in patients who developed RAH (39% vs. 21%, p = 0.026), and presenting with RAH independently predicted high mortality (HR: 1.55 [1.11-2.18]).
RAH is common and has a more aggressive clinical course, including increased mortality. Patients surviving an episode of AH should undergo intense alcohol use disorder therapy to prevent RAH.
在经历一次酒精性肝炎（AH）发作后，酒精复发很常见。然而，复发性酒精性肝炎（RAH）的临床特征、危险因素和预后意义尚未得到很好的描述。
对 2014 年至 2021 年间在西班牙 28 家医院因 AH 发作住院的患者进行了一项基于登记的研究。收集了基线人口统计学和实验室变量。使用 Cox 回归分析探讨了 RAH 的危险因素。我们分析了指数 AH 发作的严重程度，并将其与 RAH 进行了比较。通过 Kaplan-Meier 曲线和对数秩检验评估长期生存情况。共纳入 1118 例患者进行分析，其中 125 例（11%）在随访期间发生 RAH（中位数：17 [7-36] 个月）。在恢复饮酒的患者中，RAH 的发生率为 22%。复发的中位时间为 14（8-29）个月。患有 RAH 的患者有更多的精神共病。发生 RAH 的危险因素包括年龄<50 岁、酒精使用量>10 U/d 和肝功能失代偿史。与首次 AH 相比，RAH 的临床更严重（MELD 更高、更频繁的 ACLF 和 HE）。此外，在 RAH 后随访期间戒酒的患者较少（18%对 45%，p<0.001）。最重要的是，发生 RAH 的患者长期死亡率更高（39%对 21%，p=0.026），并且 RAH 的发生独立预测死亡率高（HR：1.55 [1.11-2.18]）。
RAH 很常见，且具有更具侵袭性的临床过程，包括更高的死亡率。幸存 AH 发作的患者应接受强烈的酒精使用障碍治疗，以预防 RAH。
