title: Determinants of long-term outcome in severe alcoholic hepatitis.
abstract: BACKGROUND
  Although short-term outcome in severe alcoholic hepatitis (SAH) is well described, its long-term course remains uncharacterised.
  
  
  OBJECTIVE
  To assess determinants of long-term outcome in SAH.
  
  
  METHODS
  Data were recorded from a cohort with SAH (admission Discriminant Function (DF) ≥32). Kaplan-Meier (KM) and Cox proportional hazards survival analyses were performed to determine predictors of outcome.
  
  
  RESULTS
  One hundred and nine patients were included; 63.3% male, aged 49.6 ± 9.4 years with median follow-up of 40.7 months (95% CI 37.2-44.3). Median DF was 58, 86.2% had cirrhosis and 65.1% received corticosteroids and/or pentoxifylline. Overall mortality was 57.8%, 96.8% of deaths being liver-related and 65.1% occurring after the index hospitalisation. Estimated 5-year survival was 31.8%. Hepatorenal syndrome was the only baseline factor independently associated with mortality (HR 3.78, 95% CI 1.98-7.19, P < 0.0001), although it predicted short-term, rather than long-term outcome (median survival 0.52 months, 95% CI 0.43-0.61). Of the 87 patients (79.8%) who survived index hospitalisation, 65.1% experienced recidivism. Abstinence at last follow-up remained the only independent predictor of survival in multivariate analysis (HR 0.370, 95% CI 0.168-0.818, P = 0.014). Five-year survival was higher in abstainers (75.3%) compared with relapsed and continued drinkers (26.8% and 21.0%, respectively, P = 0.005). However, the survival benefit from abstinence only became statistically significant at 18 months postdischarge (HR 2.714, 95% CI 0.995-7.404, P = 0.051).
  
  
  CONCLUSIONS
  Estimated 5-year survival after index hospitalisation with SAH is 31.8% with alcohol relapse occurring in two-thirds of patients. Abstinence remains the only independent predictor of long-term survival. Novel strategies to improve abstinence after admission with SAH are urgently needed.
authors.affiliation: Department of Medicine, Brighton and Sussex Medical School, Brighton, UK.
authors.forename: J R
authors.initials: JR
authors.lastname: Potts
authors.forename: S
authors.initials: S
authors.lastname: Goubet
authors.forename: M A
authors.initials: MA
authors.lastname: Heneghan
authors.forename: S
authors.initials: S
authors.lastname: Verma
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006519:Hepatitis, Alcoholic / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D010431:Pentoxifylline / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D013695:Temperance; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D005938:Glucocorticoids; D010975:Platelet Aggregation Inhibitors; D010431:Pentoxifylline