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Journal ArticleDOI

People who survive an episode of severe alcoholic hepatitis should be advised to maintain total abstinence from alcohol.

01 Jun 2018-Hepatology (Hepatology)-Vol. 67, Iss: 6, pp 2479-2480
TL;DR: It is found that beyond 6 months, alcohol relapse, defined as consumption of 30 g/day, was an independent predictor of mortality with a dose-related effect on the hazard ratio (HR).
About: This article is published in Hepatology.The article was published on 2018-06-01 and is currently open access. It has received 3 citations till now. The article focuses on the topics: Alcohol Abstinence & Alcoholic hepatitis.

Summary (1 min read)

Jump to: [Introduction] and [Hepatology]

Introduction

  • People who survive an episode of severe alcoholic hepatitis should be advised to maintain total abstinence from alcohol.
  • Participants enrolled in the STOPAH trial were treated for 28 days with prednisolone, pentoxifylline, both or placebo (3).

Hepatology

  • Survival in patients with severe alcoholic hepatitis alive at 90 days, by subsequent drinking behaviour.
  • Survival times, and mortality endpoints, were calculated with respect to the treatment start date or, if not recorded, the date of randomization; cases were censored at the time of liver transplantation, the limit of follow-up or day 450, whichever occurred first.

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Citations
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Journal ArticleDOI
TL;DR: In this article, the authors discuss the importance of preventing first decompensation and summarizes the evidence for etiologic and etiology-independent (most important, nonselective beta-blockers and statins) therapies.

15 citations

References
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Journal ArticleDOI
TL;DR: Pentoxifylline did not improve survival in patients with alcoholic hepatitis and prednisolone was associated with a reduction in 28-day mortality that did not reach significance and with no improvement in outcomes at 90 days or 1 year.
Abstract: BACKGROUND Alcoholic hepatitis is a clinical syndrome characterized by jaundice and liver impairment that occurs in patients with a history of heavy and prolonged alcohol use. The short-term mortality among patients with severe disease exceeds 30%. Prednisolone and pentoxifylline are both recommended for the treatment of severe alcoholic hepatitis, but uncertainty about their benefit persists. METHODS We conducted a multicenter, double-blind, randomized trial with a 2-by-2 factorial design to evaluate the effect of treatment with prednisolone or pentoxifylline. The primary end point was mortality at 28 days. Secondary end points included death or liver transplantation at 90 days and at 1 year. Patients with a clinical diagnosis of alcoholic hepatitis and severe disease were randomly assigned to one of four groups: a group that received a pentoxifylline-matched placebo and a prednisolone-matched placebo, a group that received prednisolone and a pentoxifylline-matched placebo, a group that received pentoxifylline and a prednisolone-matched placebo, or a group that received both prednisolone and pentoxifylline. RESULTS A total of 1103 patients underwent randomization, and data from 1053 were available for the primary end-point analysis. Mortality at 28 days was 17% (45 of 269 patients) in the placebo–placebo group, 14% (38 of 266 patients) in the prednisolone–placebo group, 19% (50 of 258 patients) in the pentoxifylline–placebo group, and 13% (35 of 260 patients) in the prednisolone–pentoxifylline group. The odds ratio for 28-day mortality with pentoxifylline was 1.07 (95% confidence interval [CI], 0.77 to 1.49; P = 0.69), and that with prednisolone was 0.72 (95% CI, 0.52 to 1.01; P = 0.06). At 90 days and at 1 year, there were no significant between-group differences. Serious infections occurred in 13% of the patients treated with prednisolone versus 7% of those who did not receive prednisolone (P = 0.002). CONCLUSIONS Pentoxifylline did not improve survival in patients with alcoholic hepatitis. Prednisolone was associated with a reduction in 28-day mortality that did not reach significance and with no improvement in outcomes at 90 days or 1 year. (Funded by the National Institute for Health Research Health Technology Assessment program; STOPAH EudraCT number, 2009-013897-42, and Current Controlled Trials number, ISRCTN88782125.)

452 citations

Journal ArticleDOI
TL;DR: The baseline Model for End‐Stage Liver Disease score was not predictive of long‐term outcome, while Lille score and alcohol relapse were independent prognostic factors.

136 citations


"People who survive an episode of se..." refers background or methods in this paper

  • ...dependent effect of drinking on mortality observed by Louvet et al.((1)) Participants enrolled in the STOPAH trial were treated for 28 days with prednisolone, pentoxifylline, both, or placebo....

    [...]

  • ...Thus, while Louvet et al.((1)) found a dose-related effect of drinking on theHR for death above a threshold of 30g/day, we have shown that a return to drinking, at any level, confers a dose-related increase in the risk of death....

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  • ...Patients categorized their drinking behavior at day 90 as: (1) abstinent or (2) drinking daily at low levels (men, 24 g; women, 16 g); (3) moderate levels (men,>24 but 60 g; women,>16 but 40 g); or (4) high levels (men,>60 g; women,>40 g)....

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  • ...as determinants of outcome in people with severe alcoholic hepatitis.((1)) Stephen R....

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  • ...We read with interest the article published in HEPATOLOGY by Louvet et al.((1)) highlighting factors influencing outcomes in people with severe alcoholic hepatitis....

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Journal ArticleDOI
TL;DR: Homozygosity for rs738409:G in PNPLA3 confers significant additional risk of medium-term mortality in patients with severe alcoholic hepatitis, and may be taken into account when considering treatment options for these patients.

50 citations


"People who survive an episode of se..." refers background or methods or result in this paper

  • ...Our use of sex-specific drinking thresholds, based on our previous finding that sex is an independent risk factor for mortality in people with severe alcoholic hepatitis who return to drinking,((2)) contrasts with the French group’s use of a generic drinking threshold; this may explain the difference in our findings....

    [...]

  • ...Patients categorized their drinking behavior at day 90 as: (1) abstinent or (2) drinking daily at low levels (men, 24 g; women, 16 g); (3) moderate levels (men,>24 but 60 g; women,>16 but 40 g); or (4) high levels (men,>60 g; women,>40 g)....

    [...]

  • ...The effect of drinking behavior on outcome has also been examined in data collected in the Steroids and Pentoxyfylline for Severe Alcoholic Hepatitis (STOPAH) trial.((2)) Patients were classified, in the original published analysis, as abstinent or drinking....

    [...]

  • ...00001).((2)) We have reexamined these data in an attempt to replicate the dose-...

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  • ...We have shown previously that homozygosity for rs738409:G in PNPLA3 is an independent risk factor for medium-term mortality in this population.((2)) Both this genetic variant and sex should be added to the risk factors identified by Louvet et al....

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