Natural history and development of a novel composite endpoint in patients with alcohol-associated hepatitis: Data from a prospective multicenter study

作者：Srinivasan Dasarathy, Wanzhu Tu, Nicole Welch, Samer Gawrieh, Yunpeng Yu, Qing Tang, Carla Kettler, Arun J. Sanyal, Gyöngyi Szabó, Vijay H. Shah, Ramón Bataller, Laura E. Nagy, Craig J. McClain, Naga Chalasani, Thomas A. Kerr, Mack C. Mitchell, for AlcHepNet Investigators · 发表于：Hepatology · 年份：2025 · DOI：10.1097/hep.0000000000001513 · 被引用次数：11 · 研究领域：Alcohol Consumption and Health Effects、Liver Disease Diagnosis and Treatment、Substance Abuse Treatment and Outcomes

BACKGROUND AIMS: The clinical course and outcomes of alcohol-associated hepatitis (AH) remain poorly understood. Major adverse liver outcomes do not capture the added risk of return to drinking. We examined the natural history of AH and developed a composite endpoint using a contemporary observational cohort of AH. APPROACH RESULTS: A cohort of 1127 participants: 712 AH patients, 256 heavy drinking controls without clinically evident liver disease, and 159 healthy controls, were prospectively followed for 6 months at 8 United States centers as part of the Alcoholic Hepatitis Network (AlcHepNet) consortium. Outcomes included mortality and a composite endpoint (AlcHepNet composite index) that included death, liver transplantation, hepatic decompensation (new onset/worsening ascites, HE, variceal bleeding), liver-related hospital admission, MELD increase ≥5, and return to drinking. Of 712 AH patients (age 45±10.7 y; 59.1% male), 558 (79.0%) had severe and 148 (21.0%) had moderate AH, 232 (32.5%) died, and 86 (12.1%) underwent liver transplantation. Mortality rates in moderate AH and severe AH were 0.7% versus 17.2% (30 d), 3.4% versus 26.5% (90 d), and 8.8% versus 30.5% (180 d), respectively (all p <0.001). Composite liver/alcohol use events were noted in 459 (64.5%) AH patients. Higher MELD score, lower mean arterial pressure, and baseline leukocytosis were associated with higher 90-day mortality in AH (all p <0.05). College education and higher ALP were associated with lower m...