Moderate alcohol-associated hepatitis : A real-world multicenter study
Idalsoaga, F. (Western University and London Health Sciences Centre)
Díaz, L.A. (University of California San Diego)
Dunn, W. (University of Kansas Medical Center)
Mehta, H. (University of Kansas Medical Center)
Muñoz, K. (Escuela de Medicina. Pontificia Universidad Católica de Chile)
Caldentey, V. (Escuela de Medicina. Pontificia Universidad Católica de Chile)
Arnold, J. (Pontificia Universidad Católica De Chile)
Ayares, G. (Western University and London Health Sciences Centre)
Mortuza, R. (Western University and London Health Sciences Centre)
Sarin, S.K. (Institute of Liver and Biliary Sciences)
Maiwall, R. (Institute of Liver and Biliary Sciences)
Zhang, W. (Massachusetts General Hospital. Harvard Medical School)
Qian, S. (University of Florida)
Simonetto, D. (Mayo Clinic)
Singal, A.K. (University of Louisville School of Medicine)
Elfeki, M.A. (University of Louisville School of Medicine)
Ramirez-Cadiz, C. (Virginia Commonwealth University School of Medicine)
Malhi, G. (Western University and London Health Sciences Centre)
Ahmed, A. (Western University and London Health Sciences Centre)
Homsi, H. (Western University and London Health Sciences Centre)
Abid, Z. (Western University and London Health Sciences Centre)
Cabezas González, Joaquín (Instituto de Investigación Sanitaria de Valdecilla (IDIVAL))
Echavarría, V. (Instituto de Investigación Sanitaria de Valdecilla (IDIVAL))
Poca Sans, Maria (Institut de Recerca Sant Pau)
Soriano, German (Institut de Recerca Sant Pau)
Cuyàs, Berta (Institut de Recerca Sant Pau)
Ventura-Cots, Meritxell (Hospital Universitari Vall d'Hebron)
Higuera-De La Tijera, M.F. (Universidad Nacional Autónoma de México)
Ayala-Valverde, M. (Hospital El Pino)
Perez, D. (Hospital El Pino)
Gomez, J. (Hospital El Pino)
Abraldes, Juan G. (University of Alberta)
Al-Karaghouli, M. (University of Alberta)
Jalal, P.K. (Baylor College of Medicine (Houston, Estats Units d'Amèrica))
Ibrahim, M.A. (Baylor College of Medicine (Houston, Estats Units d'Amèrica))
García-Tsao, G. (Yale University School of Medicine/VA-CTt Healthcare System)
Goyes, D. (Yale University School of Medicine/VA-CTt Healthcare System)
Skladaný, L. (Slovak Medical University)
Havaj, D.J. (Slovak Medical University)
Sulejova, K. (Slovak Medical University)
Adamcova Selcanova, S. (Slovak Medical University)
Rincón, D. (Centro De Investigación Biomédica En Red De Enfermedades Hepáticas Y Digestivas)
Chacko, K.R. (Montefiore Medical Center)
Restrepo, J.C. (Grupo de Gastrohepatología de la Universidad de Antioquia)
Yaquich, P. (Hospital San Juan De Dios)
Toro, L.G. (Hospitales de San Vicente Fundación de Medellín y Rionegro)
Shah, V. (Mayo Clinic)
Arrese, Marco (Pontificia Universidad Católica De Chile)
Kamath, P.S. (Mayo Clinic)
Bataller, Ramon (Hospital Clínic i Provincial de Barcelona)
Arab, Juan Pablo (Virginia Commonwealth University)
Universitat Autònoma de Barcelona

Fecha:	2025
Resumen:	Background: 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. Methods: 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. Results: 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). Conclusions: 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.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Alcohol ; Alcohol-associated hepatitis ; Alcohol-associated liver disease ; Cirrhosis ; End-stage liver disease ; Outcome prediction
Publicado en:	Hepatology Communications, Vol. 9 Núm. 4 (24 2025) , p. e0673, ISSN 2471-254X

DOI: 10.1097/HC9.0000000000000673
PMID: 40131003

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