| Título : |
Identification of optimal therapeutic window for steroid use in severe alcohol-associated hepatitis: A worldwide study |
| Tipo de documento : |
documento electrónico |
| Autores : |
Juan Carlos Restrepo Gutiérrez, |
| Fecha de publicación : |
2021 |
| Títulos uniformes : |
Journal of Hepatology
|
| Idioma : |
Inglés (eng) |
| Palabras clave : |
alcohol alcoholic hepatitis alcohol-associated liver disease alcoholic liver disease cirrhosis steroids corticosteroids MELD Maddrey discriminant function |
| Resumen : |
Background & Aims: Corticosteroids are the only effective therapy for severe alcohol-associated hepatitis (AH), defined by a model for end-stage liver disease (MELD) score >20. However, there are patients who may be too sick to benefit from therapy. Herein, we aimed to identify the range of MELD scores within which steroids are effective for AH. Methods: We performed a retrospective, international multicenter cohort study across 4 continents, including 3,380 adults with a clinical and/or histological diagnosis of AH. The main outcome was mortality at 30 days. We used a discrete-time survival analysis model, and MELD cut-offs were established using the transform-the-endpoints method. Results: In our cohort, median age was 49 (40–56) years, 76.5% were male, and 79% had underlying cirrhosis. Median MELD at admission was 24 (19–29). Survival was 88% (87–89) at 30 days, 77% (76–78) at 90 days, and 72% (72–74) at 180 days. A total of 1,225 patients received corticosteroids. In an adjusted-survival-model, corticosteroid use decreased 30-day mortality by 41% (hazard ratio [HR] 0.59; 0.47–0.74; p 51. The type of corticosteroids used (prednisone, prednisolone, or methylprednisolone) was not associated with survival benefit (p = 0.247). Conclusion: Corticosteroids improve 30-day survival only among patients with severe AH, especially with MELD scores between 25 and 39. |
| Mención de responsabilidad : |
Juan Pablo Arab, Luis Antonio Díaz, Natalia Baeza, Francisco Idalsoaga, Eduardo Fuentes-López, Jorge Arnold, Carolina A. Ramírez, Dalia Morales-Arraez, Meritxell Ventura-Cots, Edilmar Alvarado-Tapias, Wei Zhang, Virginia Clark, Douglas Simonetto, Joseph C. Ahn, Seth Buryska, Tej I. Mehta, Horia Stefanescu, Adelina Horhat, Andreea Bumbu, Winston Dunn, Bashar Attar, Rohit Agrawal, Zohaib Syed Haque, Muhammad Majeed, Joaquín Cabezas, Inés García-Carrera, Richard Parker, Berta Cuyàs, Maria Poca, German Soriano, Shiv K. Sarin, Rakhi Maiwall, Prasun K. Jalal, Saba Abdulsada, María Fátima Higuera-de la Tijera, Anand V. Kulkarni, P Nagaraja Rao, Patricia Guerra Salazar, Lubomir Skladaný, Natália Bystrianska, Veronica Prado, Ana Clemente-Sanchez, Diego Rincón, Tehseen Haider, Kristina R. Chacko, Fernando Cairo, Marcela de Sousa Coelho, Gustavo A. Romero30, Florencia D. Pollarsky, Juan Carlos Restrepo, Susana Castro-Sanchez, Luis G. Toro, Pamela Yaquich, Manuel Mendizabal, Maria Laura Garrido, A |
| Referencia : |
J Hepatol. 2021 Nov;75(5):1026-1033. |
| DOI (Digital Object Identifier) : |
10.1016/j.jhep.2021.06.019 |
| PMID : |
34166722 |
| En línea : |
https://linkinghub.elsevier.com/retrieve/pii/S0168827821004396 |
| Enlace permanente : |
https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=5849 |
Identification of optimal therapeutic window for steroid use in severe alcohol-associated hepatitis: A worldwide study [documento electrónico] / Juan Carlos Restrepo Gutiérrez, . - 2021. Obra : Journal of HepatologyIdioma : Inglés ( eng) | Palabras clave : |
alcohol alcoholic hepatitis alcohol-associated liver disease alcoholic liver disease cirrhosis steroids corticosteroids MELD Maddrey discriminant function |
| Resumen : |
Background & Aims: Corticosteroids are the only effective therapy for severe alcohol-associated hepatitis (AH), defined by a model for end-stage liver disease (MELD) score >20. However, there are patients who may be too sick to benefit from therapy. Herein, we aimed to identify the range of MELD scores within which steroids are effective for AH. Methods: We performed a retrospective, international multicenter cohort study across 4 continents, including 3,380 adults with a clinical and/or histological diagnosis of AH. The main outcome was mortality at 30 days. We used a discrete-time survival analysis model, and MELD cut-offs were established using the transform-the-endpoints method. Results: In our cohort, median age was 49 (40–56) years, 76.5% were male, and 79% had underlying cirrhosis. Median MELD at admission was 24 (19–29). Survival was 88% (87–89) at 30 days, 77% (76–78) at 90 days, and 72% (72–74) at 180 days. A total of 1,225 patients received corticosteroids. In an adjusted-survival-model, corticosteroid use decreased 30-day mortality by 41% (hazard ratio [HR] 0.59; 0.47–0.74; p 51. The type of corticosteroids used (prednisone, prednisolone, or methylprednisolone) was not associated with survival benefit (p = 0.247). Conclusion: Corticosteroids improve 30-day survival only among patients with severe AH, especially with MELD scores between 25 and 39. |
| Mención de responsabilidad : |
Juan Pablo Arab, Luis Antonio Díaz, Natalia Baeza, Francisco Idalsoaga, Eduardo Fuentes-López, Jorge Arnold, Carolina A. Ramírez, Dalia Morales-Arraez, Meritxell Ventura-Cots, Edilmar Alvarado-Tapias, Wei Zhang, Virginia Clark, Douglas Simonetto, Joseph C. Ahn, Seth Buryska, Tej I. Mehta, Horia Stefanescu, Adelina Horhat, Andreea Bumbu, Winston Dunn, Bashar Attar, Rohit Agrawal, Zohaib Syed Haque, Muhammad Majeed, Joaquín Cabezas, Inés García-Carrera, Richard Parker, Berta Cuyàs, Maria Poca, German Soriano, Shiv K. Sarin, Rakhi Maiwall, Prasun K. Jalal, Saba Abdulsada, María Fátima Higuera-de la Tijera, Anand V. Kulkarni, P Nagaraja Rao, Patricia Guerra Salazar, Lubomir Skladaný, Natália Bystrianska, Veronica Prado, Ana Clemente-Sanchez, Diego Rincón, Tehseen Haider, Kristina R. Chacko, Fernando Cairo, Marcela de Sousa Coelho, Gustavo A. Romero30, Florencia D. Pollarsky, Juan Carlos Restrepo, Susana Castro-Sanchez, Luis G. Toro, Pamela Yaquich, Manuel Mendizabal, Maria Laura Garrido, A |
| Referencia : |
J Hepatol. 2021 Nov;75(5):1026-1033. |
| DOI (Digital Object Identifier) : |
10.1016/j.jhep.2021.06.019 |
| PMID : |
34166722 |
| En línea : |
https://linkinghub.elsevier.com/retrieve/pii/S0168827821004396 |
| Enlace permanente : |
https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=5849 |
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