SNFGE SNFGE
 
Thématique :
- Foie (hors cancers)
Originalité :
Très original
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2017/11  
 
  2017 Nov;66(5):1464-1473.  
  doi: 10.1002/hep.29240.  
 
  Main drivers of outcome differ between short term and long term in severe alcoholic hepatitis: A prospective study.  
 
  Louvet A, Labreuche J, Artru F, Bouthors A, Rolland B, Saffers P, Lollivier J, Lemaître E, Dharancy S, Lassailly G, Canva-Delcambre V, Duhamel A, Mathurin P  
  https://www.ncbi.nlm.nih.gov/pubmed/28459138  
 
 

Abstract

Understanding the mechanisms of outcome according to the time frame can help optimize the therapeutic development in severe alcoholic hepatitis. We assessed short-term and long-term survival in severe alcoholic hepatitis based on baseline disease severity, extent of therapeutic improvement, long-term influence of alcohol relapse, and their interaction. Data and alcohol consumption were prospectively recorded in 398 patients treated with corticosteroids in the short term (from corticosteroid initiation to 6 months) and long term (from 6 months to maximum follow-up time). Cumulative incidence rate of first alcohol relapse was 25.2%, 33.7%, and 35.2% at 1, 3, and 5 years, respectively. Alcohol relapse (≥30 g/day) was not associated with mortality (P = 0.24) during the short-term period (1,606 patient-months at risk), but the Lille (P < 0.0001) and Model for End-Stage Liver Disease (P < 0.0001) scores were independent prognostic factors. In patients who were alive at 6 months (median follow-up, 42 months; interquartile range 11-88), corresponding to 10,413 patient-months at risk, alcohol consumption (≥30 g/day) was associated with mortality (hazard ratio, 3.9; P < 0.0001). Additional analysis with abstinent patients as a reference showed a dose effect of alcohol on the hazard ratio of death: 2.36 (P = 0.052) for 1-29 g/day, 3.2 (P = 0.003) for 30-49 g/day, 3.51 (P < 0.0001) for 50-99 g/day, and 5.61 (P < 0.0001) for ≥ 100 g/day. The baseline Model for End-Stage Liver Disease score was not predictive of long-term outcome, while Lille score (P = 0.02) and alcohol relapse (P < 0.0001) were independent prognostic factors.

CONCLUSION:

This study shows that new therapeutic development for severe alcoholic hepatitis must target liver injury in the short term and alcohol consumption in the long term; thus, health agencies can endorse future study designs adapted to the time frame of factors influencing mortality; with this in mind, drug-targeting mechanisms involved in liver injury should only be tested for the short-term period. (Hepatology 2017;66:1464-1473).

 

 
Question posée
 
Comment améliorer la prise en charge à court et à long terme des patients traités pour une hépatite alcoolique aiguë ?
 
Question posée
 
Dans les 6 mois, les scores de Lille et MELD sont des facteurs pronostiques indépendants et pas la rechute de l’alcool . En revanche chez les patients survivants après 6 mois, la rechute de l’alcool (>30g/j) est associée à la mortalité (x4) avec un effet –dose ainsi que le score de Lille.
 
Commentaires

Une lapalissade : s’occuper vraiment de l’alcool lorsque le foie va mieux !

 
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