Alcoholic hepatitis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assosciate Editor(s)-In-Chief: Prashanth Saddala M.B.B.S
Overview
Natural history, complication, and prognosis
Natural history
- Alcoholic liver disease may progress to one of the following stages:[1] [2]
- Fatty liver or hepaticsteatosis
- Steatohepatitis defined as Alcoholic Hepatitis or alcoholic steatonecrosis
- Fibrosis
- Cirrhosis and hepatocellular carcinoma (HCC)
- The liver biopsy of around 20-40% of the individuals with steatosis is suggestive of steatohepatitis
- After development of steatohepatitis, the hepatic change is irreversible, even after the abstinence
- Compared to steatosis, development of Alcoholic Hepatitis in subjects with alcoholic liver disease is accompanied nine -times higher risk of developing cirrhosis as well as 40 % chance of 180- days mortality.[3]
Prognosis
- Poor prognostic factors include:
- Ascites
- Elevated bilirubin
- Elevated [prothrombin time]] (PT)
- Encephalopathy
- Hepatic fibrosis and cirrhosis
- Leukocytosis not due to other causes
- Renal failure
- Discriminant function, as described above, is a predictor or severity.
- DF > 32 – Mortality 35% without steroids, in patients without encephalopathy. Mortality 45% in patients with encephalopathy.
- Abstinence appears to help slow or stop the progression of alcohol associated liver disease.
- In patients with advanced disease, cirrhosis can develop in patients who stop, but is much more likely to develop in those patients who continue to drink.
- Maddrey, et al #maddrey described the Discriminant Function (DF) formula to determine patients who might respond:
- DF = 4.6 x (PT – control PT) + Total Bilirubin
- DF > 32 has been been associated with a high death rate, up to 50% in some studies, with improved prognosis with steroid treatment.
- A recent study showed a fall in one month mortality from 35 to 6%. Another showed a fall in six month mortality 55 to 16%.
- Effect on long term mortality not clear
References
- ↑ Testino G (2008). "Alcoholic diseases in hepato-gastroenterology: a point of view". Hepatogastroenterology. 55 (82–83): 371–7. PMID 18613369.
- ↑ Testino G (2013). "Alcoholic hepatitis". J Med Life. 6 (2): 161–7. PMC 3725441. PMID 23904876.
- ↑ Frazier TH, Stocker AM, Kershner NA, Marsano LS, McClain CJ (2011). "Treatment of alcoholic liver disease". Therap Adv Gastroenterol. 4 (1): 63–81. doi:10.1177/1756283X10378925. PMC 3036962. PMID 21317995.