Incidence, survival and cause-specific mortality in alcoholic liver disease: a population-based cohort study

Sahlman, Perttu; Nissinen, Markku; Pukkala, Eero; Färkkilä, Martti

doi:10.3109/00365521.2016.1157889

Cited by 31 publications

(30 citation statements)

References 41 publications

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“…In Denmark, the incidence of AH for the period 1999‐2008 rose from 37 to 46 per million persons per year in men and 24 to 34 per million persons per year for women . A similar study in Finland reported increased incidence rates for AH from 37 to 65 cases per million persons per year for men and from 13 to 27 cases per million persons per year for women . In both of these cases, estimates were based on diagnostic coding, which may be less accurate and highlights the difficulty in estimating the burden of AH.…”

Section: Prevalence and Burden Of Alcohol‐associated Liver Diseasementioning

confidence: 99%

Diagnosis and Treatment of Alcohol‐Associated Liver Diseases: 2019 Practice Guidance From the American Association for the Study of Liver Diseases

et al. 2020

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Section: Prevalence and Burden Of Alcohol‐associated Liver Diseasementioning

confidence: 99%

Diagnosis and Treatment of Alcohol‐Associated Liver Diseases: 2019 Practice Guidance From the American Association for the Study of Liver Diseases

et al. 2020

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“…Alcoholic hepatitis is a serious complication of alcohol‐related liver disease characterised by recent onset jaundice and coagulopathy in heavy long‐term alcohol consumers . Its incidence in Europe is increasing and it accounts for approximately 0.7% of unplanned hospital admissions in USA …”

Section: Introductionmentioning

confidence: 99%

Systematic review with meta‐analysis: high mortality in patients with non‐severe alcoholic hepatitis

Bennett

Enki

Thursz

et al. 2019

Aliment Pharmacol Ther

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Summary Background Alcoholic hepatitis is a serious complication of alcohol misuse. Severe alcoholic hepatitis with its high mortality, has been investigated in detail but ‘nonsevere alcoholic hepatitis’ is poorly characterised. Survival of this group of patients is unknown. Aim To conduct a systematic review and meta‐analysis to determine 28‐day, 90‐day and 1‐year mortality of patients with nonsevere alcoholic hepatitis. Methods The protocol was registered on the PROSPERO database (CRD42018107451). Embase, Medline and Cochrane Central databases were searched until July 2018. All study designs reporting mortality rates in patients with nonsevere alcoholic hepatitis were eligible. Mortality data were extracted and meta‐analysis performed using a random effects model. Risk of bias was assessed by Cochrane risk of bias or National Institutes of Health quality assessment tool for case series studies. Results Twenty‐five studies (n = 1372 patients; 12 prospective) met criteria. Nonsevere was variably defined based on bilirubin, prothrombin time, and creatinine. Twenty‐eight day mortality (17 studies; n = 993) was 6% (95% CI 3%‐9%; I2 = 67.3%; P < 0.001), 90‐day mortality (15 studies; n = 755) was 7% (4%‐11%, I2 = 64.2%; P < 0.001) and 1‐year mortality (five studies; n = 234) was 13% (4%‐24%; I2 = 72%; P = 0.006). Subgroup analyses by method of diagnosis (histological vs clinical) or study design (prospective vs retrospective) did not reveal differences in mortality. Conclusion Nonsevere alcoholic hepatitis is not benign with 6% and 13% 28‐day and 1‐year mortality, respectively. This systematic review demonstrates the paucity of high quality studies in patients with nonsevere alcoholic hepatitis. Our analysis suggests that patients who do not meet criteria for severe alcoholic hepatitis are an important and hitherto overlooked clinical group. Full characterisation of clinical outcome and development of treatment strategies to reduce mortality in this group is a priority.

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“…There were no rs738409:G homozygotes among our patients, and heterozygosity was not related to short-term mortality. Finland represents a country with a high incidence of AH, presumably due to the relatively high overall consumption of alcohol and to drinking patterns favoring strong spirits (Sahlman et al, 2016). This study was carried out in experienced gastroenterological units.…”

Section: Discussionmentioning

confidence: 99%

“…Alcoholic hepatitis (AH) represents an exacerbation of alcoholic liver disease (ALD). The prognosis of AH is poor (Potts, Goubet, Heneghan, & Verma, 2013;Sahlman, Nissinen, Pukkala, & Färkkilä, 2016). The only approved firstline treatment is prednisolone (EASL, 2012).…”

Section: Introductionmentioning

confidence: 99%

Noncholesterol Sterols as Surrogate Markers in Patients with Severe Alcoholic Hepatitis

Sahlman

Nissinen

Simonen

et al. 2018

Lipids

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Severe alcoholic hepatitis (AH) is a life-threatening condition lacking good serologic markers to tailor treatment and predict recovery. We examined the cholesterol metabolism in severe AH to explore prognostic markers and evaluate the profile of cholesterol precursors, cholestanol and phytosterols, in this context. We assessed serum cholesterol, cholesterol precursors, cholestanol, phytosterols, and biochemical markers in 24 patients with severe AH treated with prednisolone and randomized to ciprofloxacin in the ratio 1:1. Response to prednisolone was assessed with the Lille model. Evaluations were made between responders and nonresponders to corticosteroid treatment and during follow-up for 180 days. The findings were compared with those from patients with primary sclerosing cholangitis (PSC) (n = 156) and healthy individuals (n = 124). Responders to prednisolone had ~56-60% higher (p-value 0.032-0.044) serum ratios to cholesterol of phytosterols, while the lathosterol/campesterol ratio was ~76% (p = 0.031) lower compared to nonresponders. Stigmasterol/cholesterol predicted response to corticosteroid therapy. Surrogate markers of cholesterol synthesis (lathosterol and desmosterol) inversely reflected those of absorption (cholestanol and phytosterols) in PSC and controls (r-range -0.247 to -0.559, p < 0.01 for all), contrary to AH patients, among whom this reciprocal regulation was partially recovered on day 90 (lathosterol: r-range -0.733 to -0.952, p < 0.05 for all). AH patients had ~26% lower lathosterol/cholesterol, but 1.13-3.87-fold higher cholestanol/cholesterol and sitosterol/cholesterol compared to control groups (p < 0.05 for all). Median ferritin concentration at baseline was ~37% lower (p = 0.011) among the responders. Cholesterol precursors and phytosterols have a disease-specific profile in AH. Phytosterols and ferritin may serve as surrogate markers for short-term response.

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Incidence, survival and cause-specific mortality in alcoholic liver disease: a population-based cohort study

Cited by 31 publications

References 41 publications

Diagnosis and Treatment of Alcohol‐Associated Liver Diseases: 2019 Practice Guidance From the American Association for the Study of Liver Diseases

Diagnosis and Treatment of Alcohol‐Associated Liver Diseases: 2019 Practice Guidance From the American Association for the Study of Liver Diseases

Systematic review with meta‐analysis: high mortality in patients with non‐severe alcoholic hepatitis

Noncholesterol Sterols as Surrogate Markers in Patients with Severe Alcoholic Hepatitis

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