Clinical Characteristics Of 204 Cases Of Severe Alcoholic Hepatitis And Its Association With Alcoholic Liver Disease Related Acute-on-chronic Liver Failure

Objective:Severe alcoholic hepatitis(SAH)is an acute liver decompensation in patients with alcoholic liver disease,with high clinical short-term mortality.Patients with SAH may suffer from alcoholic liver disease related acute-on-chronic liver failure(ALD-ACLF),which is characterized by one or more organ failure,if there are predispositions such as infection or heavy drinking in a short period of time.The occurrence of acute-on-chronic liver failure leads to rapid progression of the disease and will affect the response rate of patients to steroids and whether liver transplantation should be given priority or not.Therefore,the occurrence and severity of ALD-ACLF play a key role in the evaluation of SAH diseases and the selection of therapeutic schemes.The relationship between SAH and ALD-ACLF remains unknown.It is not clear whether ALD-ACLF is a special type of alcoholic liver disease or just the clinical progression stage of SAH.The prevalence of ACLF in SAH and its influence on the prognosis of SAH remains to be explored.We retrospectively analyzed the clinical characteristics of 204 SAH patients,and compared the clinical characteristics and prognosis between ALD-ACLF patients and non-ALD-ACLF patients,to explore the relationship between SAH and ALD-ACLF,and to provide basis for disease management,prognosis evaluation and treatment of SAH.Methods:Clinical data of 204 SAH patients admitted to the Department of Hepatology of the First Hospital of Jilin University from March 2012 to December 2019 were collected and retrospectively analyzed.According to the definition of ACLF by the EASL,SAH is divided into ALD-ACLF group and non-ALD-ACLF group,and the clinical characteristics and prognosis between the two groups are analyzed and compared.SPSS 21.0 software and Excel software were applied to sort out and analyze the data.Results:1.General characteristics of SAH patients.Among 204 SAH patients,194(95.1%)were male and 10(4.9%)were female,with an average age of 49.8±8.3 years.There were 50 cases(24.5%)of ALD-ACLF and 154 cases(75.5%)of non-ALD-ACLF.Among the 50 ALD-ACLF patients,17cases(34.0%)were ACLF-1,26 cases(52.0%)were ACLF-2,and 7 cases(14.0%)were ACLF-3.160 SAH patients were followed up,of which 6 received liver transplantation and 154 did not receive liver transplantation.44 SAH patients lost to follow-up.2.Complications and organ failures in SAH patients.Among 204 SAH patients,44(21.6%)cases were hepatic encephalopathy,41(20.1%)cases were spontaneous bacterial peritonitis,32(15.7%)cases were gastrointestinal hemorrhage,and 3(1.5%)case was hepatorenal syndrome.Among 204 SAH patients,103(50.5%)were liver failure,24(11.8%)were coagulation failure,16(7.8%)were renal failure,15(7.4%)were respiratory failure,10(4.9%)were nervous system failure,and 3(1.5%)were circulatory failure.3.Clinical characteristics of SAH patients with 28-day survival and death.Among 154 SAH patients who were followed up and did not undergo liver transplantation,135(87.7%)survived for 28 days and 19(12.3%)died.Compared with the survival group,the incidence of liver failure,coagulation failure,respiratory failure,nervous system failure,circulatory failure,hepatic encephalopathy in the death group was higher than that in the survival group(P < 0.05).The levels of ?-glutamyl transpeptidase and lymphocyte count in the death group are lower than that in the survival group(P < 0.05).The ratio of neutrophils to lymphocytes,indirect bilirubin,urea,creatinine,and INR in the death group are higher than that in the survival group(P < 0.05).4.Clinical characteristics of SAH patients with 90-day survival and death.Among 154 SAH patients who received follow-up and did not undergo liver transplantation,113(73.4%)survived for 90 days and 41(26.6%)died.Compared with the survival group,the incidence of coagulation failure,nervous system failure,circulatory failure and hepatic encephalopathy in the death group is higher than that in the survival group(P < 0.05),the ?-glutamyl transpeptidase and cholinesterase level in the death group is lower than that in the survival group(P < 0.05),indirect bilirubin,urea,the prothrombin time and INR in the death group are higher than that in the survival group(P < 0.05).5.Clinical characteristics of ALD-ACLF patients and non-ALD-ACLF patients in SAH: Among 204 SAH patients,50(24.5%)were ALD-ACLF patients and 154(75.5%)were non-ALD-ACLF patients.Compared with non-ALD-ACLF group,the incidence of hepatic encephalopathy and gastrointestinal bleeding in ALD-ACLF group is higher than that in non-ALD-ACLF group(P < 0.05).The white blood cell count,neutrophil count,neutrophil to lymphocyte ratio,total bilirubin,direct bilirubin,indirect bilirubin,urea,serum creatinine,prothrombin time and INR in ALD-ACLF group are higher than those in non-ALD-ACLF group(P < 0.05).6.Prognostic score of ALD-ACLF patients and non-ALD-ACLF patients.Compared with non-ALD-ACLF group,the Maddery Discriminant function,MELD score,ABIC score,CLIF-C OF score and CLIF-C ACLF score of ALD-ACLF group are higher than those of non-ALD-ACLF group(P < 0.05).7.Analysis of short-term mortality of ALD-ACLF patients and non-ALD-ACLF patients.Among the 113 non-ALD-ACLF patients who received follow-up and did not undergo liver transplantation,106 survived for 28 days and 7 died,with mortality of 6.2%.Among the 41 ALD-ACLF patients who received follow-up and did not undergo liver transplantation,29 survived for 28 days and 12 died,with mortality of 29.3%.The difference in 28-day mortality between ALD-ACLF group and non-ALD-ACLF group was statistically significant(P < 0.05).The 28-day mortality of ACLF-1 and ACLF-2 and ACLF-3 were 8.3%,22.7% and 85.7% respectively.The 28-day mortality of ALD-ACLF patients is related to ACLF grade.Among the 113 non-ALD-ACLF patients who received follow-up and did not undergo liver transplantation,94 survived for 90 days and 19 died,with mortality of 16.8%.Among the 41 ALD-ACLF patients who were followed up and did not undergo liver transplantation,19 survived for 90 days and 22 died,with a mortality rate of 53.7%.The difference in 90-day mortality between ALD-ACLF group and non-ALD-ACLF group was statistically significant(P < 0.05).The 90-day mortality rates of ACLF-1 and ACLF-2 and ACLF-3 were 41.7%,50.0% and 85.7% respectively.The 90-day mortality rate of ALD-ACLF patients is related to ACLF grade.Conclusions:1.The most frequent organ failure in SAH patients is liver failure,followed by coagulation failure,kidney failure,respiratory failure,nervous system failure and circulatory failure.2.The 28-day and 90-day mortality of SAH patients is associated with organ failure.3.The morbidity of ALD-ACLF in SAH patients is 24.5%,ACLF-1,ACLF-2 and ACLF-3 are 34.0%,52.0% and 14.0% respectively.4.The mortality of SAH patients is related to ALD-ACLF grade.The higher the ACLF grade,the higher the mortality at 28 days and 90 days.