Medical Management of Severe Alcoholic Hepatitis: Expert Review from the Clinical Practice Updates Committee of the AGA Institute

Mitchell, Mack C.; Friedman, Lawrence S.; McClain, Craig J.

doi:10.1016/j.cgh.2016.08.047

Cited by 75 publications

(49 citation statements)

References 72 publications

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“…Very recent data from Cousins’ laboratory documented a marked increase in the zinc transporter, ZIP14, associated with experimental polymicrobial sepsis and inflammation [11•] ZIP14 −/− mice had improved outcome; zinc supplementation also improved outcome. Because patients with severe alcoholic hepatitis have a systemic inflammatory response syndrome similar to septic patients, it will be interesting to see if these new findings from intensive care unit patients can be translated to alcoholic hepatitis subjects [12]. …”

Section: Overview Of Zinc Metabolismmentioning

confidence: 99%

Role of Zinc in the Development/Progression of Alcoholic Liver Disease

McClain

Vatsalya

Cave

2017

Curr Treat Options Gastro

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Section: Overview Of Zinc Metabolismmentioning

confidence: 99%

Role of Zinc in the Development/Progression of Alcoholic Liver Disease

McClain

Vatsalya

Cave

2017

Curr Treat Options Gastro

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“…Nevertheless, in the present study, some patients whose Lille score was >0.45 received corticosteroids for longer time periods (Table S1). Severe alcoholic hepatitis patients without contraindication to corticosteroids, such as hepatitis B virus infection, tuberculosis, or uncontrollable infection, were recommended to be treated with prednisolone 40 mg/day or methylprednisolone 32 mg/day for 28 days . There is a possibility that differences in the dose, duration, and/or type of corticosteroid affected each patient's prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…Liver biopsy was not required for inclusion. Severe alcoholic hepatitis was defined as fulfilling the criteria of alcoholic hepatitis and a MELD score of > 20 and/or an MDF score ≥ 32 at admission . The MELD scores were calculated using the following formula: 9.57 × ln creatinine (mg/dL) + 3.78 × ln total bilirubin (mg/dL) + 11.20 × ln INR + 6.43 .…”

Section: Methodsmentioning

confidence: 99%

A Lille model for predicting the response of severe alcoholic hepatitis to corticosteroid treatment in Japanese patients

Suzuki

Kakisaka

Suzuki

et al. 2019

Hepatology Research

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Aim Corticosteroids are the most widely used agents for the treatment of severe alcoholic hepatitis (SAH). The therapeutic effectiveness of corticosteroids is assessed by the Lille model, which has been validated well in patient cohorts in North America and Europe; however, its usefulness has not yet been confirmed independently in Japanese patients. The present study aimed to determine whether the Lille model could predict the prognosis of SAH in Japanese patients. Methods This was a retrospective cohort study including 32 SAH patients who were admitted to our institute from April 2011 to February 2018. According to the previously validated Lille model cut‐off value, patients who received corticosteroids were classified as corticosteroid responders or non‐responders (with responders obtaining a Lille score ≥ 0.45), followed by assessment for the 6‐month prognosis. Results Out of 32 patients, 26 were treated with corticosteroids. The 28‐day and 6‐month mortality rates in the corticosteroid‐treated group were 23.1% and 46.2%, respectively. The median Lille score was significantly higher in patients who died or underwent liver transplantation (0.647) than in those who survived without undergoing transplantation (0.226; P < 0.0182). The 6‐month transplant‐free survival rate of non‐responders (Lille score ≥ 0.45) was significantly lower (27.3%; 95% confidence interval, 9.0–58.6%) than that of responders (Lille score < 0.45, 73.3%; 95% confidence interval, 46.7–90.0%; P = 0.0149, log–rank test). Conclusions The Lille score could be useful for predicting the 6‐month prognosis of Japanese SAH patients after corticosteroid therapy.

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“…In addition, detection of P. gingivalis in liver biopsy specimens from patients with AAH by polymerase chain reaction or immunohistochemistry should be a gold standard in the future, but liver biopsies are not routinely performed for the diagnosis of ALD in the United States. (43) Because little is known about the role of P. gingivalis in ALD development/ progression, we analyzed immune responses to P. gingivalis as independent factors to estimate their individual effects. In addition, determining the presence or absence of PD in controls and subjects with alcoholic hepatitis would be important in future studies.…”

Section: Discussionmentioning

confidence: 99%

Porphyromonas gingivalis as a Possible Risk Factor in the Development/Severity of Acute Alcoholic Hepatitis

et al. 2018

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Bacterial infection is frequently observed in patients with alcoholic liver disease (ALD). We examined a possible role of Porphyromonas gingivalis in the development/progression and severity of disease in patients with acute alcoholic hepatitis (AAH). Plasma specimens from 47 patients with AAH (16 moderate, Model for End‐Stage Liver Disease [MELD] score <20]; 31 severe, MELD score >20) and 22 healthy controls (HCs) were collected. Clinical, drinking history (lifetime drinking history [LTDH]), and demographic data were collected. Antibody tests for immunoglobulin (Ig) G, IgM, and IgA against two P. gingivalis strains were performed. Between‐group comparisons and within‐group association analyses were carried out. Patients with severe AAH showed significantly higher plasma levels of IgG, IgA, and IgM against two P. gingivalis strains (W83 and 33277) compared to HCs. Patients with moderate AAH also had significantly elevated anti‐P. gingivalis IgA concentrations for both strains compared to HCs. Male patients with moderate AAH showed a significant inverse association in LTDH and anti‐P. gingivalis IgM. The aspartate aminotransferase:alanine aminotransferase ratio was positively associated with IgM of both strains in male patients with moderate AAH. Female patients with severe AAH showed a significant association between MELD scores and W83 IgM. Conclusion: Antibody response to P. gingivalis in AAH is elevated. Significantly elevated plasma anti‐P. gingivalis IgG, IgA, and IgM in severe AAH provide preliminary data that P. gingivalis could be a novel risk factor in the development/severity of AAH.

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Medical Management of Severe Alcoholic Hepatitis: Expert Review from the Clinical Practice Updates Committee of the AGA Institute

Cited by 75 publications

References 72 publications

Role of Zinc in the Development/Progression of Alcoholic Liver Disease

Role of Zinc in the Development/Progression of Alcoholic Liver Disease

A Lille model for predicting the response of severe alcoholic hepatitis to corticosteroid treatment in Japanese patients

Porphyromonas gingivalis as a Possible Risk Factor in the Development/Severity of Acute Alcoholic Hepatitis

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