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Identification of optimal therapeutic window for steroid use in severe alcohol-associated hepatitis: A worldwide study / Juan Carlos Restrepo Gutiérrez  

Público ISBD 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 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

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Alcohol-related liver disease: Clinical practice guidelines by the Latin American Association for the Study of the Liver (ALEH) / Juan Carlos Restrepo Gutiérrez    

Público ISBD Título : Alcohol-related liver disease: Clinical practice guidelines by the Latin American Association for the Study of the Liver (ALEH) Tipo de documento : documento electrónico Autores : Juan Carlos Restrepo Gutiérrez, Fecha de publicación : 2019 Títulos uniformes : Annals of Hepatology Idioma : Inglés (eng) Palabras clave : Alcohol  alcohol use disorder  alcohol-related liver disease  alcoholic hepatitis  alcoholic liver disease  cirrhosis  clinical practice guidelines  corticosteroids Resumen : Alcohol-related liver disease (ALD) is a major cause of advanced chronic liver disease in Latin-America, although data on prevalence is limited. Public health policies aimed at reducing the alarming prevalence of alcohol use disorder in Latin-America should be implemented. ALD comprises a clinical-pathological spectrum that ranges from steatosis, steatohepatitis to advanced forms such as alcoholic hepatitis (AH), cirrhosis and hepatocellular carcinoma. Besides genetic factors, the amount of alcohol consumption is the most important risk factor for the development of ALD. Continuous consumption of more than 3 standard drinks per day in men and more than 2 drinks per day in women increases the risk of developing liver disease. The pathogenesis of ALD is only partially understood and recent translational studies have identified novel therapeutic targets. Early forms of ALD are often missed and most clinical attention is focused on AH, which is defined as an abrupt onset of jaundice and liver-related complications. In patients with potential confounding factors, a transjugular biopsy is recommended. The standard therapy for AH (i.e. prednisolone) has not evolved in the last decades yet promising new therapies (i.e. G-CSF, N-acetylcysteine) have been recently proposed. In both patients with early and severe ALD, prolonged abstinence is the most efficient therapeutic measure to decrease long-term morbidity and mortality. A multidisciplinary team including alcohol addiction specialists is recommended to manage patients with ALD. Liver transplantation should be considered in the management of patients with end-stage ALD that do not recover despite abstinence. In selected cases, increasing number of centers are proposing early transplantation for patients with severe AH not responding to medical therapy. Mención de responsabilidad : Juan P Arab, Juan P Roblero, Jose Altamirano, Fernando Bessone, Roberta Chaves Araujo, Fatima Higuera-De la Tijera, Juan Carlos Restrepo, Aldo Torre, Alvaro Urzua, Douglas A Simonetto, Juan G Abraldes, Nahum Méndez-Sánchez, Fernando Contreras, Michael R Lucey, Vijay H Shah, Helena Cortez-Pinto, Ramon Bataller Referencia : Ann Hepatol. 2019 May - Jun;18(3):518-535 DOI (Digital Object Identifier) : 10.1016/j.aohep.2019.04.005 PMID : 31053546 Derechos de uso : CC BY-NC-ND En línea : https://linkinghub.elsevier.com/retrieve/pii/S1665268119300419 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4250 Alcohol-related liver disease: Clinical practice guidelines by the Latin American Association for the Study of the Liver (ALEH) [documento electrónico] / Juan Carlos Restrepo Gutiérrez,  . - 2019. Obra : Annals of Hepatology Idioma : Inglés (eng) Palabras clave : Alcohol  alcohol use disorder  alcohol-related liver disease  alcoholic hepatitis  alcoholic liver disease  cirrhosis  clinical practice guidelines  corticosteroids Resumen : Alcohol-related liver disease (ALD) is a major cause of advanced chronic liver disease in Latin-America, although data on prevalence is limited. Public health policies aimed at reducing the alarming prevalence of alcohol use disorder in Latin-America should be implemented. ALD comprises a clinical-pathological spectrum that ranges from steatosis, steatohepatitis to advanced forms such as alcoholic hepatitis (AH), cirrhosis and hepatocellular carcinoma. Besides genetic factors, the amount of alcohol consumption is the most important risk factor for the development of ALD. Continuous consumption of more than 3 standard drinks per day in men and more than 2 drinks per day in women increases the risk of developing liver disease. The pathogenesis of ALD is only partially understood and recent translational studies have identified novel therapeutic targets. Early forms of ALD are often missed and most clinical attention is focused on AH, which is defined as an abrupt onset of jaundice and liver-related complications. In patients with potential confounding factors, a transjugular biopsy is recommended. The standard therapy for AH (i.e. prednisolone) has not evolved in the last decades yet promising new therapies (i.e. G-CSF, N-acetylcysteine) have been recently proposed. In both patients with early and severe ALD, prolonged abstinence is the most efficient therapeutic measure to decrease long-term morbidity and mortality. A multidisciplinary team including alcohol addiction specialists is recommended to manage patients with ALD. Liver transplantation should be considered in the management of patients with end-stage ALD that do not recover despite abstinence. In selected cases, increasing number of centers are proposing early transplantation for patients with severe AH not responding to medical therapy. Mención de responsabilidad : Juan P Arab, Juan P Roblero, Jose Altamirano, Fernando Bessone, Roberta Chaves Araujo, Fatima Higuera-De la Tijera, Juan Carlos Restrepo, Aldo Torre, Alvaro Urzua, Douglas A Simonetto, Juan G Abraldes, Nahum Méndez-Sánchez, Fernando Contreras, Michael R Lucey, Vijay H Shah, Helena Cortez-Pinto, Ramon Bataller Referencia : Ann Hepatol. 2019 May - Jun;18(3):518-535 DOI (Digital Object Identifier) : 10.1016/j.aohep.2019.04.005 PMID : 31053546 Derechos de uso : CC BY-NC-ND En línea : https://linkinghub.elsevier.com/retrieve/pii/S1665268119300419 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4250

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