SNFGE SNFGE
 
Thématique :
- Foie
Originalité :
Réexamen
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2017/12  
 
  017 Dec;66(6):1842-1853.  
  doi: 10.1002/hep.29338.  
 
  Alcohol abstinence in patients surviving an episode of alcoholic hepatitis: Prediction and impact on long-term survival.  
 
  Altamirano J, López-Pelayo H, Michelena J, Jones PD, Ortega L, Ginès P, Caballería J, Gual A, Bataller R, Lligoña A  
  https://www.ncbi.nlm.nih.gov/pubmed/28646515  
 
 

Abstract

Alcoholic hepatitis (AH) is the most severe form of alcoholic liver disease. Most studies have focused on short-term prognosis, whereas factors associated with long-term survival are largely unknown. The aims of our study were to (1) determine the impact of complete abstinence from alcohol on long-term survival and (2) identify prognostic factors at admission capable of predicting abstinence during long-term follow-up in patients with AH. One hundred forty-two patients with biopsy-proven AH that survived the first episode were included. Demographic, psychiatric, and biochemical variables at admission and drinking status during follow-up were obtained. Cox regression, logistic regression, and classification and regression trees (CART) analyses were used for statistical analysis. Overall mortality was 38% with a median follow-up of 55 months. During follow-up, complete abstinence was reported in 39% and was associated with better long-term survival (hazard ratio, 0.53; P = 0.03). After adjustment for baseline prognostic scoring systems (Model for End-Stage Liver Disease and age, bilirubin, international normalized ratio, creatinine scores), complete abstinence was independently associated with survival (P < 0.05). Age and lack of past alcoholism treatments were independently associated with complete abstinence (P < 0.001 and P = 0.02, respectively) during follow-up. CART analysis generated a simple and practical algorithm based on the combination of past alcoholism treatments and age. Using CART analysis, we stratified 2 subgroups of patients with high (65%) and low (26%-29%) rates of complete abstinence after an episode of AH.

CONCLUSION:

Complete abstinence after an episode of AH positively impacts long-term survival. The combination of 2 variables easily obtained at admission might be useful to predict long-term abstinence after an episode of AH. Strategies aimed at promoting alcohol abstinence in these patients are necessary. (Hepatology 2017;66:1842-1853).

 

 
Question posée
 
Déterminer l'impact de l'abstinence complète à l'alcool sur la survie à long terme et identifier des facteurs pronostiques à l'admission capables de prédire l'abstinence à long terme chez les patients pris en charge pour une hépatite alcoolique aiguë.
 
Question posée
 
La mortalité était de 38% avec un suivi médian de 4,5 ans. L'abstinence complète était 39% et bien associée à une meilleure survie. Les facteurs associés à l'abstinence était l'âge et l'absence de traitements antérieurs pour la maladie alcoolique.
 
Commentaires

Truisme mais souligne très fortement la nécessité de prendre en charge l’addiction à l’alccol le plus précocément possible, des efforts considérables sont nécessaires.

 
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