Survival from alcoholic hepatitis has not improved over time

Abstract

Purpose/BackgroundWe aimed to describe changes in survival in alcoholic hepatitis (AH) over time by examining published data.MethodsA systematic literature search of Ovid Embase and PubMed was undertaken using the MESH terms ‘hepatitis, alcoholic’ to identify randomised controlled trials (RCT) and observational studies (OS) in alcoholic hepatitis. Data were extracted from included studies regarding 28-day, 90-day, 180-day mortality, as well as biochemical and clinical data.ResultsAfter review of the literature search results, 77 studies published between 1971 and 2016 were analysed, which included data from a total of 8,184 patients. Overall mortality from AH was 26% at 28 days, 29% at 90 days and 44% at 180 days after admission. No changes in mortality over time were observed in univariable analysis at 28 days or 90 days after admission (Pearson correlation r -0.216, p = 0.098, and r 0.121 p = 0.503 respectively). A small but statistically significant increase in mortality was seen in 180-day mortality (r 0.461 p = 0.036). However, after meta-regression to adjust for other factors associated with mortality at each time point, no changes in mortality were seen. Sub-group analysis did not reveal any changes in mortality over time in different study types, or when only biopsy-proven or severe disease were considered.ConclusionThere has been no improvement in mortality from AH. This is not explained by changes in severity of disease. This emphasises the urgent need for effective treatments for this alcoholic hepatitis.

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

“…This concurs with a meta-analysis of mortality in all patients with alcoholic hepatitis, which did not show a change in 28-or 180-day mortality over time. 55 Despite improvements in the management of acutely unwell patients over the last four decades, this steady rate of mortality over time emphasises the need to concentrate attention on patients with nonsevere alcoholic hepatitis to develop methods to improve their outcome.…”

Only in the darkness can you see the stars: Severe alcoholic hepatitis and higher grades of acute-on-chronic liver failure

“…Hughes et al demonstrated that there has been no improvement in mortality from AH because of the lack of effective treatments in this patient group. 7 We believe that healthy donor FMT may be a potential treatment option that requires further prospective high-quality studies for SAH and higher grades of ACLF. The results of ongoing randomized trial comparing CS to FMT in SAH-ACLF are highly anticipated (NCT03091010).…”

The NAD Metabolome is Functionally Depressed in Patients Undergoing Liver Transplantation for Alcohol-related Liver Disease

“…AH is characterized clinically by jaundice and liver failure(4) with steatohepatitis (alcoholic steatohepatitis, ASH) and cholestasis seen histologically (5). AH is associated with poor shortterm mortality, which has not improved over time despite multiple tested interventions (6).…”