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Gene signature-MELD score and alcohol relapse determine long-term prognosis of patients with severe alcoholic hepatitis.

Authors
  • Deltenre, Pierre1, 2
  • Trépo, Eric1, 3
  • Fujiwara, Naoto4
  • Goossens, Nicolas4, 5
  • Marot, Astrid6
  • Dubois, Margaux7
  • Spahr, Laurent5
  • Henrion, Jean8
  • Moreno, Christophe1, 3
  • Hoshida, Yujin4
  • 1 Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, C.U.B. Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium. , (Belgium)
  • 2 Department of Gastroenterology and Hepatology, Clinique St Luc, Bouge, Belgium. , (Belgium)
  • 3 Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Brussels, Belgium. , (Belgium)
  • 4 Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
  • 5 Division of Gastroenterology and Hepatology, Geneva University Hospital, Geneva, Switzerland. , (Switzerland)
  • 6 Department of Gastroenterology and Hepatology, CHU UCL Namur, Université Catholique de Louvain, Yvoir, Belgium. , (Belgium)
  • 7 Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland. , (Switzerland)
  • 8 Department of Gastroenterology and Hepatology, Hôpital de Jolimont, Haine-Saint-Paul, Belgium. , (Belgium)
Type
Published Article
Journal
Liver international : official journal of the International Association for the Study of the Liver
Publication Date
Mar 01, 2020
Volume
40
Issue
3
Pages
565–570
Identifiers
DOI: 10.1111/liv.14265
PMID: 31568650
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The gene-signature-model for end stage liver disease (gs-MELD) score has been shown to be a strong predictor of 6-month survival in severe alcoholic hepatitis (AH). Currently, only a few studies have evaluated the long-term prognosis of patients with severe AH. To assess the prognostic value of the gs-MELD score at 5 years in patients with severe AH. Forty-eight consecutive patients with AH (25 males, median age 52 years [95% IC: 48-56]) were included. The median gs-MELD score was 2.6 (95% CI: 2.2-3.0). According to the gs-MELD score, 22 patients (46%) were considered to have a poor prognosis. During a median follow-up of 29 months (95% CI: 4-43), 19 patients (40%) were abstinent and 24 patients (50%) died. At 5 years, rates of survival were 61% (95% CI: 41-81) and 26% (95% CI: 11-55) in patients with low and high gs-MELD scores (P = .001), and 81% (95% CI: 58-96) and 22% (95% CI: 10-47) in abstainers and in consumers (P < .001) respectively. In multivariable competing risk regression modelling, gs-MELD score (subdistribution hazard ratio: 5.78, 95% CI: 2.17-15.38, P < .001) and recurrent alcohol consumption (subdistribution hazard ratio: 12.18, 95% CI: 3.16-46.95, P < .001) were independently associated with 5-year mortality. Both gs-MELD score and alcohol consumption drive AH long-term prognosis. The gs-MELD score may guide the development of molecularly targeted therapies in AH. © 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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