Idalsoaga Francisco, Díaz Luis Antonio, Dunn Winston, Mehta Heer, Muñoz Karen, Caldentey Vicente, Arnold Jorge, Ayares Gustavo, Mortuza Rokhsana, Sarin Shiv K, Maiwall Rakhi, Zhang Wei, Qian Steve, Simonetto Douglas, Singal Ashwani K, Elfeki Mohamed A, Ramirez-Cadiz Carolina, Malhi Gurpreet, Ahmed Adan, Homsi Hoomam, Abid Zinia, Cabezas Joaquín, Echavarría Victor, Poca Maria, Soriano German, Cuyas Berta, Ventura Cots Meritxell, Higuera-De La Tijera María Fátima, Ayala-Valverde Maria, Perez Diego, Gomez Jaime, Abraldes Juan G, Al-Karaghouli Mustafa, Jalal Prasun K, Ibrahim Mohamad Ali, García-Tsao Guadalupe, Goyes Daniela, Skladaný Lubomir, Havaj Daniel J, Sulejova Karolina, Adamcova Selcanova Svetlana, Rincón Diego, Chacko Kristina R, Restrepo Juan C, Yaquich Pamela, Toro Luis G, Shah Vijay, Arrese Marco, Kamath Patrick S, Bataller Ramon, Arab Juan Pablo
Departamento De Gastroenterología, Escuela De Medicina, Pontificia Universidad Católica De Chile, Santiago, Chile.
Division of Gastroenterology and Hepatology, Department of Medicine, Western University & London Health Sciences Centre, London, Canada.
Hepatol Commun. 2025 Mar 24;9(4). doi: 10.1097/HC9.0000000000000673. eCollection 2025 Apr 1.
Severe alcohol-associated hepatitis (sAH) is a well-characterized disease with high short-term mortality. However, there is limited research on those with a "less severe condition" (moderate AH). This study aims to characterize in-depth patients with moderate AH (mAH), including the performance of mortality scoring systems, key prognostic factors, and survival over time.
A multicenter retrospective cohort study (2009-2019) included patients with mAH (MELD score ≤20 at admission). Cox regression and receiver operating characteristic curves with AUC were used for analysis.
We included 1845 patients with AH (20 centers, 8 countries) between 2009 and 2019. mAH was defined as a MELD score ≤20 at admission. Twenty-four percent met the criteria for an mAH episode. Patients with mAH tend to be older and have a higher proportion of females, with a median MELD of 17 (15-19), Maddrey discriminant function (mDF) of 33 (22-40), the trajectory of serum bilirubin of 0.83 (0.60-1.21), and neutrophil-to-lymphocyte ratio (NLR) of 5 (2.96-8.60). The primary causes of death in mAH included multiple organ failure (34.1%) and infections (16.6%). The cumulative survival rates at 30, 90, and 180 days were 94.3%, 90.4%, and 88.2%, respectively. In multivariable analysis, age was the only significant predictor of 30-day mortality (HR 1.49, 95% CI: 1.27-1.76, p<0.001). Mortality prediction models showed poor performance, with AUC for MELD (0.671), mDF (0.726), trajectory of serum bilirubin (0.733), and NLR (0.697).
Patients with moderate AH exhibited a mortality of 11.8% at 6 months, primarily driven by multiple organ failure and infections. These patients also exhibit a different clinical profile compared to those with sAH. Tailored models and therapeutic strategies are needed to improve long-term outcomes in mAH.
严重酒精性肝炎（sAH）是一种特征明确、短期死亡率高的疾病。然而，对于病情“较轻”（中度酒精性肝炎）患者的研究有限。本研究旨在深入描述中度酒精性肝炎（mAH）患者的特征，包括死亡率评分系统的表现、关键预后因素及长期生存率。
一项多中心回顾性队列研究（2009 - 2019年）纳入了入院时终末期肝病模型（MELD）评分≤20的mAH患者。采用Cox回归分析及绘制带有曲线下面积（AUC）的受试者工作特征曲线进行分析。
2009年至2019年间，我们纳入了1845例酒精性肝炎患者（来自8个国家的20个中心）。mAH定义为入院时MELD评分≤20。24%的患者符合mAH发作标准。mAH患者往往年龄较大，女性比例较高，MELD中位数为17（15 - 19），Maddrey判别函数（mDF）为33（22 - 40），血清胆红素变化轨迹为0.83（0.60 - 1.21），中性粒细胞与淋巴细胞比值（NLR）为5（2.96 - 8.60）。mAH患者的主要死亡原因包括多器官功能衰竭（34.1%）和感染（16.6%）。30天、90天和180天的累积生存率分别为94.3%、90.4%和88.2%。在多变量分析中，年龄是30天死亡率的唯一显著预测因素（风险比1.49，95%置信区间：1.27 - 1.76，p<0.001）。死亡率预测模型表现不佳，MELD的AUC为0.671，mDF为0.726，血清胆红素变化轨迹为0.733，NLR为0.697。
中度酒精性肝炎患者6个月时的死亡率为11.8%，主要由多器官功能衰竭和感染所致。与sAH患者相比，这些患者还表现出不同的临床特征。需要定制模型和治疗策略以改善mAH患者的长期预后。
