Bacterial Infections in Patients With Severe Alcohol‐Associated Hepatitis: Drivers of Organ Failure and Mortality

作者：Laura Buttler, Jan Stange, Nikolaos Pyrsopoulos, Tarek Hassanein, Heiner Wedemeyer, Benjamin Maasoumy, Markus Busch, the VTL‐308 study group · 发表于：Liver International · 年份：2025 · DOI：10.1111/liv.70111 · 被引用次数：6 · 研究领域：Alcohol Consumption and Health Effects、Liver Disease Diagnosis and Treatment、Liver Disease and Transplantation

BACKGROUND: Severe alcohol-associated hepatitis (sAH) is a life-threatening condition with limited treatment options. Although corticosteroids offer some benefit in short-term survival, their use remains controversial due to concerns about increased infection risk. Infections are a major cause of mortality in sAH; however, the reasons for this remain unclear. METHODS: A post hoc analysis of the prospective VTL-308 multicentre trial on 151 patients with sAH was performed. Competing-risk models evaluated predictors of infections, the influence of corticosteroids on infection risk, and the impact of infections on the clinical outcomes up to 1 year of follow-up. RESULTS: Among 151 patients, 90 (59.6%) developed infections. The most frequent were urinary tract (34.4%) and bloodstream (30%) infections. The causative pathogen was isolated in 40 patients, with Enterococcus spp. being the most common (35%). Fungal infections were detected in 19 (12.6%) patients. Corticosteroid use was not associated with increased bacterial (subdistribution-hazard ratio [sHR] =0.74; 95% Confidence Interval (CI): 0.42-1.33; p = 0.32) or fungal infection risk (sHR = 1.74; 95% CI: 0.59-5.15; p = 0.31). Infections significantly increased multi-organ failure (MOF) in the univariate (sHR = 2.31; 95% CI: 1.03-5.17; p = 0.04) and multivariate models (sHR = 2.46; 95% CI: 1.12-5.39; p = 0.03). 37.8% of infected patients died versus 13.1% of non-infected patients. Bacterial infections strongly predicted mortalit...