[The amount of alcohol intake, upper gastrointestinal bleeding, acute renal failure and hepatic encephalopathy as the risk factors implied in the increase of patients with alcoholic hepatitis].
BACKGROUND
Acute renal failure (ARF) worsens the prognosis of patients with alcoholic hepatitis (HA). Other factors like the amount of alcohol intake, upper gastrointestinal bleeding (UGB) or hepatic encephalopathy (HE) are not considered at present in any prognostic index.


OBJECTIVE
To evaluate if the amount of alcohol intake, development of UGB, ARF and/or HE are associated with high mortality in patients with AH.


METHODS
Consecutive patients with diagnosis of AH were included. Demographic, laboratory data, complications and mortality were registered. A comparison was performed between survivors and non-survivors.


RESULTS
Seventy-one patients were included. Median amount of alcohol consumption was 187.7 g/day, and was superior in men (190.8 vs. 169 g/day, p = 0.02) and in patients who developed ARF (219.6 vs. 144.1 g/day, p = 0.001). Maddrey s index was higher in patients who died than those who survive (111.4 vs. 52.9, p = 0.02). No differences between groups were recorded regarding Glasgow and MELD scales. ARF was the only one complication related with higher risk of death (RR = 6.7, p = 0.02). Isolated UGB and HE were non-significantly associated with mortality, but combination of two or three complications was highly significantly associated with mortality risk: ARF and HE (OR = 8.9, p = 0.001), HE and UGB (OR = 6.7, p = 0.01) and ARF + UGB + HE (OR = 10, p = 0.001).


CONCLUSIONS
The amount of alcohol intake is associated with development of ARF. ARF was the most significant risk factor associated with mortality. The presence of two or three complications increases the mortality risk significantly. Key words: acute renal failure, hepatic encephalopathy, risk factors, mortality, alcoholic hepatitis, Mexico.
Higuera-de la Tijera
M F
MF
Servicio de Gastroenterología, Hospital General de México OD., México, D. F. fatimahiguera@yahoo.com.mx
Pérez-Hernández
J L
JL
Servín-Caamaño
A L
AL
Serralde-Zúñiga
A E
AE
Cruz-Palacios
A
A
D058186:Acute Kidney Injury / Q000150:complications*; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications*; D006501:Hepatic Encephalopathy / Q000150:complications*; D006519:Hepatitis, Alcoholic / Q000150:complications* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D041742:Upper Gastrointestinal Tract; D055815:Young Adult