Management of severe acute alcoholic hepatitis in France: results of a national survey: R1.

Since 2010, little data have been available in France on the management of severe acute alcoholic hepatitis (sAH). In order to obtain a current "mapping" of the management of sAH in France, a practice survey was conducted from 04/2022 to 07/2023. A Google questionnaire pre-established by a working group was sent to all the hepatogastroenterology departments of general hospitals (nUH) and hepatology departments of university hospitals (UH). The results are expressed as means ± SD. The data included demographics, number of sAH treated per centre with corticosteroids (C) or N-acetylcysteine (NAC) combined with C, existence of an sAH treatment protocol, systematic use of transjugular liver biopsy (LB) and treatment modalities. Treatment: use of C alone or C -NAC. A total of 457 physicians responded (R): mean age 40 years (12.5); UH 53.3%, nUH 46.7%, hepatologists 57%, gastroenterologists 39%, juniors 21%. The number of sAH cases treated with C or CNAC per center was 25 (0 to 300); this number was higher in UH than in nUH: 34 (29) vs nUH 15.4 (13.4), p < 0.001. A treatment protocol existed in 62% of UH vs 42% of nUH, p < 0.001. LB was systematically performed in 98% of UH vs 50% of others, p < 0.001. The time to obtain LB was 3.4 days (UH) vs 4.9 days (nUH), p < 0.001. 83% of respondents waited 4 days (2-6) before starting treatment in the event of a documented bacterial infection. The treatment administered was: C alone in 70% of patients (UH vs nUH,ns), NAC use: UH 40% vs nUH 47.3% (ns). 70% of respondents were responsible for initiating treatment (65% in UH vs 72% in nUH (p < 0.01). The treatment was much more often initiated by senior doctors (80.6%vs 20.4% junior doctors,p < 0.001). 62% of respondents used preemptive treatment before corticosteroid treatment in the event of a positive HBs antigen; 59.4% in UH vs 65% in nUH (p = 0.004) . 76% performed an upper gastrointestinal endoscopy if none had been previously performed (77% in UH vs 75% in nUH,ns). The results of this national practice study,carried out in a large sample of doctors practising in university and non -university hospitals show a disparity in the use of LB in cases of suspected sAH, since 50% of respondents outside university hospitals do not use LB, mainly due to the lack of local availability. Dual CNAC therapy is used fairly frequently.