Mean Arterial Pressure at Admission Predicts 28-day Mortality in Patients With Severe Alcohol-Associated Hepatitis.
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Ventura-Cots Meritxell, Clemente Ana, Alvarado-Tapias Edilmar, Ravi Sujan, Cuyas Berta, Tanguy Marion, Poca Maria, Jager Marion, Fernández-Carrillo Carlos, Arteel Gavin E, Villagrasa Ares, Aguilar-Amorós Anna, Argemi Josepmaria, Abraldes Juan G, Bosques Francisco, Brown Robert S, Garcia-Taso Guadalupe, Genesca Juan, Schanbl Bernd, Mathurin Phillipe, Louvet Alexander, Lucey Michael R, Shawcross Debbie L, Verna Elisabeth, Gawrieh Samer, Dasarathy Srinivasan, Tu Wanzhu, Kamath Patrick S, Chalasani Naga P, McClain Craig J, Szabo Gyongyi, Tang Qing, Barton Bruce, Nagy Laura E, Shah Vijay H, Sanyal Arun J, Mitchell Mack C, Singal Ashwani K, Soriano German, Rautou Pierre Emmanuel, Bataller Ramon
Аннотация
METHODS: We analyzed a multicenter, prospective cohort of 323 patients hospitalized with AH, with validation in an independent cohort of 290 patients. Survival was evaluated using Kaplan-Meier curves and compared with the log-rank (Mantel-Cox) test. Cox proportional hazards models were used to estimate hazard ratios for mortality, adjusted for Model for end stage liver disease score. Mechanistic insights were explored through assessment of cardiovascular biomarkers.
RESULTS: A baseline MAP <80 mm Hg was associated with significantly higher mortality at both 28 days (27.3% vs 8.0%) and 90 days (40.3% vs 15.6%; P < 0.001 for both). This association persisted after adjusting for Model for end stage liver disease score, age, and baseline hepatic encephalopathy. The incidence of infections during follow-up was similar across MAP groups (27.6% vs 22.8%), but acute kidney injury occurred more frequently in the MAP <80 mm Hg group (62% vs 38%, P < 0.001). In the validation cohort, patients with MAP <80 mm Hg also demonstrated significantly lower 28-day transplant-free survival. Although B-type natriuretic peptide and plasma renin levels were altered in patients with AH, they did not correlate with MAP values.
DISCUSSION: A baseline MAP <80 mm Hg is an independent predictor of short-term and mid-term mortality in patients with AH. Strategies aimed at restoring hemodynamic stability may improve outcomes in this high-risk population.