Abstract
Background and aims: Severe alcoholic hepatitis (SAH) is an inflammatory response with multiple morbidity factors like leucocytosis, hepatomegaly, renal failure, hepatic encephalopathy, endotoxemia, and has a high mortality rate. Accordingly, identifying therapeutic interventions that can support prognosis is the goal of research. Methods: Questionnaires were sent to 1234 medical institutions asking for information on patients with SAH during 2004 to 2008 including patients' demography, disease profile and the therapeutic interventions patients had received during hospitalization. Results: Twenty-nine hospitals had treated SAH patients, and provided full demographic data on 62 patients. Twenty-seven patients had received no treatment, 10 patients had received granulocytes/monocytes apheresis (GMA) to deplete elevated myeloid linage leucocytes, the rest had received one or more of the following treatments, corticosteroids, plasma exchange (PE) and haemodialysis (HD). Further, 23 patients had died and 39 had survived within 100 days of hospitalization. Serum creatinine (Cr) was higher in patients who had died vs patients who had survived (P=0.026). Likewise, patients with white blood cells (WBC)≥10 4/μL had higher mortality rate vs patients with WBC<10 4/μL (P=0.039). GMA in patients with WBC≥10 4/μL showed 100% prognosis vs patients with WBC≥10 4/μL who did not receive GMA (P=0.0007). Corticosteroids, PE and HD did not significantly impact prognosis of SAH patients. Conclusions: Our perception is that, patients with elevated myeloid leucocytes benefit most from GMA, while PE appears to support patients with coagulation deficiency or high plasma bilirubin and HD has indication in patients with high Cr.
| Original language | English |
|---|---|
| Pages (from-to) | 738-744 |
| Number of pages | 7 |
| Journal | Clinics and Research in Hepatology and Gastroenterology |
| Volume | 35 |
| Issue number | 11 |
| DOIs | |
| Publication status | Published - 2011 Nov |
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ASJC Scopus subject areas
- Gastroenterology
Cite this
Therapeutic strategies for severe alcoholic hepatitis. / Horie, Yoshinori; Yamagishi, Yoshiyuki; Ebinuma, Hirotoshi; Hibi, Toshifumi.
In: Clinics and Research in Hepatology and Gastroenterology, Vol. 35, No. 11, 11.2011, p. 738-744.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Therapeutic strategies for severe alcoholic hepatitis
AU - Horie, Yoshinori
AU - Yamagishi, Yoshiyuki
AU - Ebinuma, Hirotoshi
AU - Hibi, Toshifumi
PY - 2011/11
Y1 - 2011/11
N2 - Background and aims: Severe alcoholic hepatitis (SAH) is an inflammatory response with multiple morbidity factors like leucocytosis, hepatomegaly, renal failure, hepatic encephalopathy, endotoxemia, and has a high mortality rate. Accordingly, identifying therapeutic interventions that can support prognosis is the goal of research. Methods: Questionnaires were sent to 1234 medical institutions asking for information on patients with SAH during 2004 to 2008 including patients' demography, disease profile and the therapeutic interventions patients had received during hospitalization. Results: Twenty-nine hospitals had treated SAH patients, and provided full demographic data on 62 patients. Twenty-seven patients had received no treatment, 10 patients had received granulocytes/monocytes apheresis (GMA) to deplete elevated myeloid linage leucocytes, the rest had received one or more of the following treatments, corticosteroids, plasma exchange (PE) and haemodialysis (HD). Further, 23 patients had died and 39 had survived within 100 days of hospitalization. Serum creatinine (Cr) was higher in patients who had died vs patients who had survived (P=0.026). Likewise, patients with white blood cells (WBC)≥10 4/μL had higher mortality rate vs patients with WBC<10 4/μL (P=0.039). GMA in patients with WBC≥10 4/μL showed 100% prognosis vs patients with WBC≥10 4/μL who did not receive GMA (P=0.0007). Corticosteroids, PE and HD did not significantly impact prognosis of SAH patients. Conclusions: Our perception is that, patients with elevated myeloid leucocytes benefit most from GMA, while PE appears to support patients with coagulation deficiency or high plasma bilirubin and HD has indication in patients with high Cr.
AB - Background and aims: Severe alcoholic hepatitis (SAH) is an inflammatory response with multiple morbidity factors like leucocytosis, hepatomegaly, renal failure, hepatic encephalopathy, endotoxemia, and has a high mortality rate. Accordingly, identifying therapeutic interventions that can support prognosis is the goal of research. Methods: Questionnaires were sent to 1234 medical institutions asking for information on patients with SAH during 2004 to 2008 including patients' demography, disease profile and the therapeutic interventions patients had received during hospitalization. Results: Twenty-nine hospitals had treated SAH patients, and provided full demographic data on 62 patients. Twenty-seven patients had received no treatment, 10 patients had received granulocytes/monocytes apheresis (GMA) to deplete elevated myeloid linage leucocytes, the rest had received one or more of the following treatments, corticosteroids, plasma exchange (PE) and haemodialysis (HD). Further, 23 patients had died and 39 had survived within 100 days of hospitalization. Serum creatinine (Cr) was higher in patients who had died vs patients who had survived (P=0.026). Likewise, patients with white blood cells (WBC)≥10 4/μL had higher mortality rate vs patients with WBC<10 4/μL (P=0.039). GMA in patients with WBC≥10 4/μL showed 100% prognosis vs patients with WBC≥10 4/μL who did not receive GMA (P=0.0007). Corticosteroids, PE and HD did not significantly impact prognosis of SAH patients. Conclusions: Our perception is that, patients with elevated myeloid leucocytes benefit most from GMA, while PE appears to support patients with coagulation deficiency or high plasma bilirubin and HD has indication in patients with high Cr.
UR - http://www.scopus.com/inward/record.url?scp=83155180505&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=83155180505&partnerID=8YFLogxK
U2 - 10.1016/j.clinre.2011.07.005
DO - 10.1016/j.clinre.2011.07.005
M3 - Article
C2 - 21840788
AN - SCOPUS:83155180505
VL - 35
SP - 738
EP - 744
JO - Clinics and Research in Hepatology and Gastroenterology
JF - Clinics and Research in Hepatology and Gastroenterology
SN - 2210-7401
IS - 11
ER -