Prognosis and treatment of patients with acute alcoholic hepatitis.
Despite alcoholic hepatitis (AH) is the most acute manifestation of alcohol-related liver disease, its treatment remains controversial. Corticosteroids, given either as monotherapy or together with N-acetylecysteine, have been associated with a moderate short-term survival benefit in patients with severe disease. The Maddrey's discriminant function; Glasgow alcoholic hepatitis score; age, bilirubin, INR and creatinine score; and the Model for end-stage liver disease have been proposed for stratifying prognosis in AH enabling selection of the patients to treat. Definition of treatment non-responders using the Lille model after 7 days of therapy may prevent a detrimental impact of prolonged corticosteroids. Pentoxifylline is an effective alternative reducing the occurrence of hepatorenal syndrome. Emerging evidence supports use of liver transplantation in a strictly selected subset of corticosteroid non-responders.
The Royal Free Sheila Sherlock Liver Centre and UCL Institute of Liver and Digestive Health, Royal Free Hospital and UCL, London, UK.
Vassilios
V
Papastergiou
Andrew K
AK
Burroughs
Emmanuel A
EA
Tsochatzis
D000111:Acetylcysteine / Q000627:therapeutic use*; D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000975:Antioxidants / Q000627:therapeutic use*; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D006519:Hepatitis, Alcoholic / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006530:Hepatorenal Syndrome / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D018579:Patient Selection; D010431:Pentoxifylline / Q000627:therapeutic use*; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use*; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000975:Antioxidants; D010726:Phosphodiesterase Inhibitors; D010431:Pentoxifylline; D000111:Acetylcysteine
Lille score; alcoholic hepatitis; corticosteroids; liver transplantation; mortality; pentoxifylline; prognosis; prognostic scores; steroids