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Multicenter Study
. 2025 Mar 24;9(4):e0673.
doi: 10.1097/HC9.0000000000000673. eCollection 2025 Apr 1.

Moderate alcohol-associated hepatitis: A real-world multicenter study

Francisco Idalsoaga  1   2 , Luis Antonio Díaz  1   3 , Winston Dunn  4 , Heer Mehta  4 , Karen Muñoz  5 , Vicente Caldentey  5 , Jorge Arnold  1 , Gustavo Ayares  2 , Rokhsana Mortuza  2 , Shiv K Sarin  6 , Rakhi Maiwall  6 , Wei Zhang  7 , Steve Qian  8 , Douglas Simonetto  9 , Ashwani K Singal  10 , Mohamed A Elfeki  10 , Carolina Ramirez-Cadiz  11 , Gurpreet Malhi  2 , Adan Ahmed  2 , Hoomam Homsi  2 , Zinia Abid  2 , Joaquín Cabezas  12   13 , Victor Echavarría  12   13 , Maria Poca  14 , German Soriano  14 , Berta Cuyas  14 , Meritxell Ventura Cots  15 , María Fátima Higuera-De La Tijera  16 , Maria Ayala-Valverde  17 , Diego Perez  17 , Jaime Gomez  17 , Juan G Abraldes  18 , Mustafa Al-Karaghouli  18 , Prasun K Jalal  19 , Mohamad Ali Ibrahim  19 , Guadalupe García-Tsao  20 , Daniela Goyes  20 , Lubomir Skladaný  21 , Daniel J Havaj  21 , Karolina Sulejova  21 , Svetlana Adamcova Selcanova  21 , Diego Rincón  22   23 , Kristina R Chacko  24 , Juan C Restrepo  25 , Pamela Yaquich  26 , Luis G Toro  27 , Vijay Shah  9 , Marco Arrese  1 , Patrick S Kamath  9 , Ramon Bataller  28   29 , Juan Pablo Arab  1   30
Affiliations
Multicenter Study

Moderate alcohol-associated hepatitis: A real-world multicenter study

Francisco Idalsoaga et al. Hepatol Commun. .

Abstract

Background: Severe alcohol-associated hepatitis (sAH) is a well-characterized disease with high short-term mortality. However, there is limited research on those with a "less severe condition" (moderate AH). This study aims to characterize in-depth patients with moderate AH (mAH), including the performance of mortality scoring systems, key prognostic factors, and survival over time.

Methods: A multicenter retrospective cohort study (2009-2019) included patients with mAH (MELD score ≤20 at admission). Cox regression and receiver operating characteristic curves with AUC were used for analysis.

Results: We included 1845 patients with AH (20 centers, 8 countries) between 2009 and 2019. mAH was defined as a MELD score ≤20 at admission. Twenty-four percent met the criteria for an mAH episode. Patients with mAH tend to be older and have a higher proportion of females, with a median MELD of 17 (15-19), Maddrey discriminant function (mDF) of 33 (22-40), the trajectory of serum bilirubin of 0.83 (0.60-1.21), and neutrophil-to-lymphocyte ratio (NLR) of 5 (2.96-8.60). The primary causes of death in mAH included multiple organ failure (34.1%) and infections (16.6%). The cumulative survival rates at 30, 90, and 180 days were 94.3%, 90.4%, and 88.2%, respectively. In multivariable analysis, age was the only significant predictor of 30-day mortality (HR 1.49, 95% CI: 1.27-1.76, p<0.001). Mortality prediction models showed poor performance, with AUC for MELD (0.671), mDF (0.726), trajectory of serum bilirubin (0.733), and NLR (0.697).

Conclusions: Patients with moderate AH exhibited a mortality of 11.8% at 6 months, primarily driven by multiple organ failure and infections. These patients also exhibit a different clinical profile compared to those with sAH. Tailored models and therapeutic strategies are needed to improve long-term outcomes in mAH.

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Conflict of interest statement

Ramon Bataller: consulting for GSK, Novo Nordisk, and Boehringer Ingelheim. Juan G Abraldes: consulting for 89bio, Agomab, Novo Nordisk, Boehringer Ingelheim, AstraZeneca, Terumo, and Boston Pharmaceuticals. Grant support: Salix, Gilead, Cook. Lubomir Skladaný: consulting for Abbvie, Gilead, Astellas, Worwag, and ProMed. Daniel J. Havaj: Lecturing for Abbvie, Gilead, Astellas, and ProMed. German Soriano: grant support from MENDES, Grifols, and GORE. The remaining authors have no conflicts to report.

Figures

None
Graphical abstract
FIGURE 1
FIGURE 1
Kaplan-Meier curve of survival in patients with moderate and severe alcohol-associated hepatitis. Abbreviations: mAH, moderate alcohol-associated hepatitis, sAH, severe alcohol-associated hepatitis.
FIGURE 2
FIGURE 2
Adjusted survival curves stratified by MELD. The model is adjusted for age, male gender, history of cirrhosis, albumin at admission, plasma sodium at admission, and use of corticosteroids.
See this image and copyright information in PMC

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