[Severe alcoholic hepatitis in Japan]

Abstract

Multiple organ failures are frequently observed in patients with severe alcoholic hepatitis. Most of the patients have a poor prognosis similar to fluminant hepatitis. Since alcohol intake has been recently increasing in Japan, severe alcoholic hepatitis is expected to be increased. The objective of this study was to determine whether there was any factor by which prognosis of severe alcoholic hepatitis was determined. We carried out nationwide survey by asking the hospitals that are approved by the Japanese Society of Gastroenterology for current incidence of alcoholic liver disease including severe alcoholic hepatitis. We investigated correlations between various factors including blood laboratory data, presence of other organ failure, and prognosis. White blood cell counts and serum creatinine levels were higher, red blood cell counts were lower and prothrombin time were prolonged in the patients who had died than in the patients who had survived. Prevalence of infection, gastrointestinal bleeding, and disseminated intravascular coagulation was higher in the patients who had died. These results suggest that the patients with markedly elevated white blood cell counts, prolonged prothrombin time, anemia, renal failure, infection, or gastrointestinal bleeding should be treated at an earlier stage with plasma exchange, hemodialysis, and anti-coagulation therapy. Since treatment with corticosteroid hormone may worsen the prognosis of severe alcoholic hepatitis, especially with infection or gastrointestinal bleeding, co-administration of anti-bacterial agents and protective drugs for gastrointestinal tracts should be considered.