Trajectory of Serum Bilirubin Predicts Spontaneous Recovery in a Real-World Cohort of Patients with Alcoholic Hepatitis.

Parker, Richard, Cabezas, Joaquin, Altamirano, Jose, Arab, Juan Pablo, Ventura-Cots, Meritxell, Sinha, Ashish, Dhanda, Ashwin, Arrese, Marco, McCune, C Anne, Rowe, Ian A, Schnabl, Bernd, Mathurin, Phillipe, Shawcross, Debbie, Abraldes, Juan Jg, Lucey, Michael R, Garcia-Tsao, Guadalupe, Verna, Elizabeth, Brown, Robert S, Bosques-Padilla, Francisco, Vargas, Victor, Louvet, Alexandre, Holt, Andrew P and Bataller, Ramon (2021) Trajectory of Serum Bilirubin Predicts Spontaneous Recovery in a Real-World Cohort of Patients with Alcoholic Hepatitis. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. ISSN 1542-7714. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs

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Abstract

BACKGROUND AND AIMS

Alcoholic hepatitis (AH) is a severe condition with poor short-term prognosis. Specific treatment with corticosteroids slightly improves short-term survival but is associated with infection and is not used in many centers. A reliable method to identify patients who will recover spontaneously will minimise the numbers of patients who experience side effects of available treatments.

METHODS

We analysed the trajectory of serum bilirubin concentration over the course of hospital admissions in patients with AH to predict spontaneous survival and the need for treatment.

RESULTS

data from 426 patients were analysed. Based on bilirubin trajectory, patients were categorized into three groups: 'fast fallers' (bilirubin <0.8 x admission value at day 7), 'static' (bilirubin of >0.9 - <1.2 x admission value) and 'rapid risers' (bilirubin of ≥1.2 x admission bilirubin). Fast fallers had significantly better 90-day survival compared to other groups (log rank p<0.001), and showed no benefit of corticosteroid therapy (OR for survival at 28 days of treatment, 0.94, 95% CI 0.06 - 8.41). These findings remained even amongst patients with severe disease based on initial DF, GAHS or MELD scores.

CONCLUSIONS

We present an intuitive method of classifying patients with AH based on the trajectory of bilirubin over the first week of admission. It is complimentary to existing scores that identify candidates for corticosteroid treatment or assess response to treatment. This method identifies a group of patients with AH who recover spontaneously and can avoid corticosteroid therapy.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs
Subjects: WI Digestive system. Gastroenterology
Divisions: Planned IP Care > Gastroentrology
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Depositing User: Jamie Edgar
Date Deposited: 08 Feb 2021 13:21
Last Modified: 08 Feb 2021 13:21
URI: http://www.repository.uhblibrary.co.uk/id/eprint/3957

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