Real-World Utilization of Corticosteroids in Severe Alcoholic Hepatitis: Eligibility, Response, and Outcomes
<i>Background and Objectives:</i> Alcoholic hepatitis (AH) poses a medical challenge, causing moderately severe to life-threatening episodes with high short- and long-term mortality. This study aimed to explore real-world corticosteroid utilization in severe AH, response predictors, and...
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MDPI AG
2024-02-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/60/2/311 |
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| author | Ana-Maria Singeap Horia Minea Oana Petrea Madalina-Andreea Robea Ioana-Miruna Balmuș Raluca Duta Ovidiu-Dumitru Ilie Carmen Diana Cimpoesu Carol Stanciu Anca Trifan |
| author_facet | Ana-Maria Singeap Horia Minea Oana Petrea Madalina-Andreea Robea Ioana-Miruna Balmuș Raluca Duta Ovidiu-Dumitru Ilie Carmen Diana Cimpoesu Carol Stanciu Anca Trifan |
| author_sort | Ana-Maria Singeap |
| collection | DOAJ |
| description | <i>Background and Objectives:</i> Alcoholic hepatitis (AH) poses a medical challenge, causing moderately severe to life-threatening episodes with high short- and long-term mortality. This study aimed to explore real-world corticosteroid utilization in severe AH, response predictors, and patient outcomes. <i>Materials and Methods:</i> We conducted a retrospective study on patients admitted for severe AH, defined as a Maddrey Discriminant Function score equal to or above 32, at a tertiary care center. We reviewed patients’ medical observation charts to identify corticosteroid prescriptions, reasons for ineligibility, and response rates. Responders were defined based on the Lille score, and predictors of non-response were identified. Short-term (one-month) and long-term (one-year) mortality rates were calculated according to treatment and response. <i>Results:</i> Out of 310 patients enrolled with severe AH, 59% received corticosteroids, achieving a response rate of 75.4%. The reasons for not administering corticosteroids were as follows: uncontrolled infections (27.6%), renal dysfunction (20.4%), gastrointestinal bleeding (18.9%), acute pancreatitis (7.1%), uncontrolled diabetes (3.1%), and other or unknown causes (22.8%). The overall 1-month mortality rate was 12.2%, higher in non-responders (35.3%) and patients who did not receive corticosteroids (13.4%) compared to responders (3.6%). The overall 1-year mortality rate was 62.5%, similar between patients who did not receive corticosteroids (78.7%) and non-responders (77.7%) and higher compared to responders (42.8%). Predictive factors for non-response included older age (OR = 1.05, 95%CI: 1.01–1.08), concomitant cirrhosis (OR= 2.11, 95% CI: 1.064–4.20), MELD scores exceeding 30 (OR = 2.42, 95% CI: 1.21–4.80), severe hypoalbuminemia (OR = 2.46, 95%CI: 1.12–5.37), and increased serum creatinine (OR = 1.5, 95% CI: 1.1–2.03). Among the prognostic scores, MELD 3.0 score exhibited superior efficacy for short-term (AUC = 0.734, 95% CI 0.656–0.811) and long-term mortality (AUC = 0.777, 95% CI: 0.724–0.830) compared to alternative scoring systems. <i>Conclusions:</i> Low eligibility rate and poor prognosis underscore the need for effective therapies. Our findings contribute to refining risk stratification and early prediction of non-response, aiding clinicians in identifying more beneficial therapies. |
| first_indexed | 2024-03-07T22:21:55Z |
| format | Article |
| id | doaj.art-8ce16a12e18b4b938ac5f02f2b75dd38 |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-07T22:21:55Z |
| publishDate | 2024-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj.art-8ce16a12e18b4b938ac5f02f2b75dd382024-02-23T15:26:43ZengMDPI AGMedicina1010-660X1648-91442024-02-0160231110.3390/medicina60020311Real-World Utilization of Corticosteroids in Severe Alcoholic Hepatitis: Eligibility, Response, and OutcomesAna-Maria Singeap0Horia Minea1Oana Petrea2Madalina-Andreea Robea3Ioana-Miruna Balmuș4Raluca Duta5Ovidiu-Dumitru Ilie6Carmen Diana Cimpoesu7Carol Stanciu8Anca Trifan9Department of Gastroenterology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, RomaniaDepartment of Gastroenterology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, RomaniaDepartment of Gastroenterology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, RomaniaCENEMED Platform for Interdisciplinary Research, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, RomaniaCENEMED Platform for Interdisciplinary Research, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, RomaniaCENEMED Platform for Interdisciplinary Research, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, RomaniaCENEMED Platform for Interdisciplinary Research, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, RomaniaCENEMED Platform for Interdisciplinary Research, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, RomaniaDepartment of Gastroenterology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, RomaniaDepartment of Gastroenterology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania<i>Background and Objectives:</i> Alcoholic hepatitis (AH) poses a medical challenge, causing moderately severe to life-threatening episodes with high short- and long-term mortality. This study aimed to explore real-world corticosteroid utilization in severe AH, response predictors, and patient outcomes. <i>Materials and Methods:</i> We conducted a retrospective study on patients admitted for severe AH, defined as a Maddrey Discriminant Function score equal to or above 32, at a tertiary care center. We reviewed patients’ medical observation charts to identify corticosteroid prescriptions, reasons for ineligibility, and response rates. Responders were defined based on the Lille score, and predictors of non-response were identified. Short-term (one-month) and long-term (one-year) mortality rates were calculated according to treatment and response. <i>Results:</i> Out of 310 patients enrolled with severe AH, 59% received corticosteroids, achieving a response rate of 75.4%. The reasons for not administering corticosteroids were as follows: uncontrolled infections (27.6%), renal dysfunction (20.4%), gastrointestinal bleeding (18.9%), acute pancreatitis (7.1%), uncontrolled diabetes (3.1%), and other or unknown causes (22.8%). The overall 1-month mortality rate was 12.2%, higher in non-responders (35.3%) and patients who did not receive corticosteroids (13.4%) compared to responders (3.6%). The overall 1-year mortality rate was 62.5%, similar between patients who did not receive corticosteroids (78.7%) and non-responders (77.7%) and higher compared to responders (42.8%). Predictive factors for non-response included older age (OR = 1.05, 95%CI: 1.01–1.08), concomitant cirrhosis (OR= 2.11, 95% CI: 1.064–4.20), MELD scores exceeding 30 (OR = 2.42, 95% CI: 1.21–4.80), severe hypoalbuminemia (OR = 2.46, 95%CI: 1.12–5.37), and increased serum creatinine (OR = 1.5, 95% CI: 1.1–2.03). Among the prognostic scores, MELD 3.0 score exhibited superior efficacy for short-term (AUC = 0.734, 95% CI 0.656–0.811) and long-term mortality (AUC = 0.777, 95% CI: 0.724–0.830) compared to alternative scoring systems. <i>Conclusions:</i> Low eligibility rate and poor prognosis underscore the need for effective therapies. Our findings contribute to refining risk stratification and early prediction of non-response, aiding clinicians in identifying more beneficial therapies.https://www.mdpi.com/1648-9144/60/2/311severe alcoholic hepatitiscorticosteroidsmortality rateprognostic factors |
| spellingShingle | Ana-Maria Singeap Horia Minea Oana Petrea Madalina-Andreea Robea Ioana-Miruna Balmuș Raluca Duta Ovidiu-Dumitru Ilie Carmen Diana Cimpoesu Carol Stanciu Anca Trifan Real-World Utilization of Corticosteroids in Severe Alcoholic Hepatitis: Eligibility, Response, and Outcomes Medicina severe alcoholic hepatitis corticosteroids mortality rate prognostic factors |
| title | Real-World Utilization of Corticosteroids in Severe Alcoholic Hepatitis: Eligibility, Response, and Outcomes |
| title_full | Real-World Utilization of Corticosteroids in Severe Alcoholic Hepatitis: Eligibility, Response, and Outcomes |
| title_fullStr | Real-World Utilization of Corticosteroids in Severe Alcoholic Hepatitis: Eligibility, Response, and Outcomes |
| title_full_unstemmed | Real-World Utilization of Corticosteroids in Severe Alcoholic Hepatitis: Eligibility, Response, and Outcomes |
| title_short | Real-World Utilization of Corticosteroids in Severe Alcoholic Hepatitis: Eligibility, Response, and Outcomes |
| title_sort | real world utilization of corticosteroids in severe alcoholic hepatitis eligibility response and outcomes |
| topic | severe alcoholic hepatitis corticosteroids mortality rate prognostic factors |
| url | https://www.mdpi.com/1648-9144/60/2/311 |
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