Pharmacologic Treatment of Alcoholic Hepatitis: Examining Outcomes Based on Disease Severity Stratification

Ryan E Owens; Heather S Snyder; Jennifer D Twilla; Sanjaya K Satapathy

doi:10.1016/j.jceh.2016.07.003

Pharmacologic Treatment of Alcoholic Hepatitis: Examining Outcomes Based on Disease Severity Stratification

J Clin Exp Hepatol. 2016 Dec;6(4):275-281. doi: 10.1016/j.jceh.2016.07.003. Epub 2016 Jul 18.

Authors

Ryan E Owens¹, Heather S Snyder², Jennifer D Twilla², Sanjaya K Satapathy³

Affiliations

¹ University of Oklahoma College of Pharmacy, Department of Pharmacy, Clinical and Administrative Sciences, 1110 North Stonewall Avenue, Oklahoma City, OK 73117, USA.
² Methodist University Hospital, Department of Pharmacy, 1265 Union Avenue, Memphis, TN 38104, USA.
³ Methodist University Hospital Transplant Institute, University of Tennessee Health Sciences Center, Division of Surgery, Transplant Hepatology, 1265 Union Avenue, Memphis, TN 38104, USA.

Abstract

Objectives: Maddrey discriminant function (MDF) score is a measure of disease prognosis in alcoholic hepatitis (AH) used to identify patients at highest risk of mortality and determine the need for initiation of pharmacologic treatment. The purpose of this study was to evaluate the effects of pharmacologic therapy for hospitalized AH patients as stratified by MDF score.

Methods: A retrospective review of patients with an AH diagnosis admitted to a Methodist LeBonheur Healthcare adult hospital between 06/2009 and 06/2014 was conducted. Patients ≥18 years of age with an ICD-9 code for AH were evaluated.

Results: Of the 493 patients screened, 234 met the inclusion criteria, comprised of 62 patients with an MDF ≥ 32 (treatment, n = 42 vs. no treatment, n = 20) and 172 patients with an MDF < 32 (treatment, n = 15 vs. no treatment, n = 157). For the patients with an MDF ≥ 32, there was no statistically significant difference between the treatment group vs. non-treatment group regarding 28-day mortality (31% vs. 11%, respectively; P = 0.18) and 6-month mortality (45% treatment vs. 38% non-treatment; P = 0.75). For the patients with an MDF <32, there was no statistically significant difference between the treatment group vs. non-treatment group regarding 28-day mortality (0% vs. 7%, respectively; P > 0.99) and 6-month mortality (11% treatment vs. 13% non-treatment; P > 0.99). There was no difference in incidence of acute kidney injury, hepatorenal syndrome, development of infection or hepatic encephalopathy between the treatment vs. non-treatment groups.

Conclusions: Pharmacologic treatment showed no survival benefit, regardless of disease severity. Given the mortality risk seen in mild-moderate AH patients not receiving treatment and concern for a possible treatment ceiling effect in severe AH patients, more data are needed to adequately assess the utility of MDF in selecting appropriate candidates for AH treatment.

Keywords: AASLD, American Association for the Study of Liver Diseases; AH, alcoholic hepatitis; AKI, acute kidney injury; ALD, alcoholic liver disease; ARR, absolute risk reduction; GI, gastrointestinal; HRS, hepatorenal syndrome; INR, international normalized ratio; MDF, Maddrey discriminant function; MELD, Model for End-Stage Liver Disease; Maddrey discriminant function; PT, prothrombin time; SCr, serum creatinine; SD, standard deviation; eGFR, estimated glomerular filtration rate; pentoxifylline; prednisolone.