Thakurdesai Aishwarya, Kumari Anjali, Shay Henry, Elgharabawy Khaled, Winrich Evan J, Zhang Wanyu, Jackson Amber, Cave Matthew C, Kong Maiying, Zhang Xiang, Singal Ashwani K, McClain Craig J, Vatsalya Vatsalya
Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Louisville, Louisville, KY 40202, USA.
Clinical Laboratory for the Intervention Development of AUD and Organ Severity, Louisville, KY 40202, USA.
J Clin Med. 2025 Aug 31;14(17):6157. doi: 10.3390/jcm14176157.
: Alcohol-associated hepatitis (AH) is an acute inflammatory condition of alcohol-associated liver disease (ALD) with rapid progression and high mortality. The Age-Bilirubin-INR-Creatinine (ABIC) score is a static algorithm that predicts survivability in AH. The roles of alcohol drinking patterns and nutritional status in AH progression and risk of death are understudied. This study evaluates the impact of alcohol drinking patterns and nutrition on AH progression and mortality. : Sixty-one adult patients diagnosed with AH were stratified by the Model for End-Stage Liver Disease (MELD) as non-severe (MELD < 20, = 26, Gr.1) and severe (MELD ≥ 20, = 35, Gr.2). Each group was further subdivided by ABIC: low- (<6.71), intermediate- (6.71-9), and high- (>9) risk categories. We assessed different demographics: nutrition using the Controlling Nutritional Status (CONUT) score; lifetime drinking history (LTDH); recent alcohol use (AUDIT); laboratory measures (complete metabolic panel, complete blood count, and coagulation), and clinical measures (Maddrey DF, Child-Turcotte-Pugh, and Lille). : All patients showed a significant and positive correlation between ABIC and LTDH (r = 0.538, = 0.004), particularly in Gr.2 (r = 0.554, = 0.011). The low-risk Gr.2 exhibited the highest AST:ALTs. AST:ALTs were significantly associated with LTDH, AUDIT, and CONUT (R = 0.539, = 0.031). In all AH patients with intermediate mortality risk, AST:ALTs were strongly linked to CONUT and LTDH (R = 0.657, = 0.017). : Severe AH demonstrates rapid liver injury progression even when the mortality risk is low. Chronic and recent heavy alcohol consumption and poor nutrition adversely impact AH severity and mortality risk. Alcohol intake and nutritional assessments in routine clinicals could identify high-risk patients, thereby improving treatment and a favorable prognosis.
酒精性肝炎（AH）是酒精性肝病（ALD）的一种急性炎症状态，进展迅速且死亡率高。年龄-胆红素-INR-肌酐（ABIC）评分是一种预测AH患者生存能力的静态算法。饮酒模式和营养状况在AH进展及死亡风险中的作用尚未得到充分研究。本研究评估饮酒模式和营养对AH进展及死亡率的影响。61例诊断为AH的成年患者根据终末期肝病模型（MELD）分为非重度（MELD<20，n = 26，第1组）和重度（MELD≥20，n = 35，第2组）。每组再根据ABIC进一步细分：低风险（<6.71）、中度风险（6.71 - 9）和高风险（>9）类别。我们评估了不同的人口统计学特征：使用控制营养状况（CONUT）评分评估营养状况；终生饮酒史（LTDH）；近期饮酒情况（AUDIT）；实验室检查指标（全代谢组、全血细胞计数和凝血功能）以及临床指标（Maddrey DF、Child-Turcotte-Pugh和Lille评分）。所有患者的ABIC与LTDH之间均呈显著正相关（r = 0.538，p = 0.004），尤其是在第2组（r = 0.554，p = 0.011）。低风险的第2组患者AST:ALT比值最高。AST:ALT比值与LTDH、AUDIT和CONUT显著相关（R = 0.539，p = 0.03）。在所有中度死亡风险的AH患者中，AST:ALT比值与CONUT和LTDH密切相关（R = 0.657，p = 0.017）。重度AH即使在死亡风险较低时也显示出快速的肝损伤进展。长期和近期大量饮酒以及营养不良会对AH的严重程度和死亡风险产生不利影响。在常规临床中进行酒精摄入量和营养评估可以识别高危患者，从而改善治疗效果并获得良好预后。
