Recurrent alcohol-associated hepatitis is common and is associated with increased mortality.
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Gratacós-Ginès Jordi, Ruz-Zafra Pilar, Celada-Sendino Miriam, Martí-Carretero Aina, Pujol Clàudia, Martín-Mateos Rosa, Echavarría Víctor, Frisancho Luis E, García Sonia, Barreales Mónica, Tejedor-Tejada Javier, Vázquez-Rodríguez Sergio, Cañete Nuria, Fernández-Carrillo Carlos, Valenzuela María, Martí-Aguado David, Horta Diana, Quiñones Marta, Bernal-Monterde Vanesa, Acosta Silvia, Artaza Tomás, Pinazo José, Villar-Lucas Carmen, Clemente-Sánchez Ana, Badia-Aranda Ester, Giráldez-Gallego Álvaro, Rodríguez Manuel, Sancho-Bru Pau, Cabezas Joaquín, Ventura-Cots Meritxell, Fernández-Rodríguez Conrado, Aguilera Victoria, Tomé Santiago, Bataller Ramon, Caballería Juan, Pose Elisa, REHALC Registry investigators
Аннотация
APPROACH AND RESULTS: A registry-based study was done of patients admitted to 28 Spanish hospitals for an episode of AH between 2014 and 2021. Baseline demographics and laboratory variables were collected. Risk factors for RAH were investigated using Cox regression analysis. We analyzed the severity of the index episodes of AH and compared it to that of RAH. Long-term survival was assessed by Kaplan-Meier curves and log-rank tests. A total of 1118 patients were included in the analysis, 125 (11%) of whom developed RAH during follow-up (median: 17 [7-36] months). The incidence of RAH in patients resuming alcohol use was 22%. The median time to recurrence was 14 (8-29) months. Patients with RAH had more psychiatric comorbidities. Risk factors for developing RAH included age <50 years, alcohol use >10 U/d, and history of liver decompensation. RAH was clinically more severe compared to the first AH (higher MELD, more frequent ACLF, and HE). Moreover, alcohol abstinence during follow-up was less common after RAH (18% vs. 45%, p <0.001). Most importantly, long-term mortality was higher in patients who developed RAH (39% vs. 21%, p = 0.026), and presenting with RAH independently predicted high mortality (HR: 1.55 [1.11-2.18]).
CONCLUSIONS: RAH is common and has a more aggressive clinical course, including increased mortality. Patients surviving an episode of AH should undergo intense alcohol use disorder therapy to prevent RAH.