Gene signature-MELD score and alcohol relapse determine long-term prognosis of patients with severe alcoholic hepatitis

Pierre Deltenre, Eric Trépo, Naoto Fujiwara, Nicolas Goossens, Astrid Marot, Margaux Dubois, Laurent Spahr, Jean Henrion, Christophe Moreno, Yujin Hoshida

Research output: Contribution to journalArticle

Abstract

Background: The gene-signature-model for end stage liver disease (gs-MELD) score has been shown to be a strong predictor of 6-month survival in severe alcoholic hepatitis (AH). Currently, only a few studies have evaluated the long-term prognosis of patients with severe AH. Aim: To assess the prognostic value of the gs-MELD score at 5 years in patients with severe AH. Methods: Forty-eight consecutive patients with AH (25 males, median age 52 years [95% IC: 48-56]) were included. Results: The median gs-MELD score was 2.6 (95% CI: 2.2-3.0). According to the gs-MELD score, 22 patients (46%) were considered to have a poor prognosis. During a median follow-up of 29 months (95% CI: 4-43), 19 patients (40%) were abstinent and 24 patients (50%) died. At 5 years, rates of survival were 61% (95% CI: 41-81) and 26% (95% CI: 11-55) in patients with low and high gs-MELD scores (P =.001), and 81% (95% CI: 58-96) and 22% (95% CI: 10-47) in abstainers and in consumers (P <.001) respectively. In multivariable competing risk regression modelling, gs-MELD score (subdistribution hazard ratio: 5.78, 95% CI: 2.17-15.38, P <.001) and recurrent alcohol consumption (subdistribution hazard ratio: 12.18, 95% CI: 3.16-46.95, P <.001) were independently associated with 5-year mortality. Conclusions: Both gs-MELD score and alcohol consumption drive AH long-term prognosis. The gs-MELD score may guide the development of molecularly targeted therapies in AH.

Original languageEnglish (US)
JournalLiver International
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Alcoholic Hepatitis
End Stage Liver Disease
Alcohols
Recurrence
Genes
Alcohol Drinking
Survival Rate
Survival
Mortality

Keywords

  • cirrhosis
  • MELD
  • prognosis

ASJC Scopus subject areas

  • Hepatology

Cite this

Gene signature-MELD score and alcohol relapse determine long-term prognosis of patients with severe alcoholic hepatitis. / Deltenre, Pierre; Trépo, Eric; Fujiwara, Naoto; Goossens, Nicolas; Marot, Astrid; Dubois, Margaux; Spahr, Laurent; Henrion, Jean; Moreno, Christophe; Hoshida, Yujin.

In: Liver International, 01.01.2019.

Research output: Contribution to journalArticle

Deltenre, Pierre ; Trépo, Eric ; Fujiwara, Naoto ; Goossens, Nicolas ; Marot, Astrid ; Dubois, Margaux ; Spahr, Laurent ; Henrion, Jean ; Moreno, Christophe ; Hoshida, Yujin. / Gene signature-MELD score and alcohol relapse determine long-term prognosis of patients with severe alcoholic hepatitis. In: Liver International. 2019.
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abstract = "Background: The gene-signature-model for end stage liver disease (gs-MELD) score has been shown to be a strong predictor of 6-month survival in severe alcoholic hepatitis (AH). Currently, only a few studies have evaluated the long-term prognosis of patients with severe AH. Aim: To assess the prognostic value of the gs-MELD score at 5 years in patients with severe AH. Methods: Forty-eight consecutive patients with AH (25 males, median age 52 years [95{\%} IC: 48-56]) were included. Results: The median gs-MELD score was 2.6 (95{\%} CI: 2.2-3.0). According to the gs-MELD score, 22 patients (46{\%}) were considered to have a poor prognosis. During a median follow-up of 29 months (95{\%} CI: 4-43), 19 patients (40{\%}) were abstinent and 24 patients (50{\%}) died. At 5 years, rates of survival were 61{\%} (95{\%} CI: 41-81) and 26{\%} (95{\%} CI: 11-55) in patients with low and high gs-MELD scores (P =.001), and 81{\%} (95{\%} CI: 58-96) and 22{\%} (95{\%} CI: 10-47) in abstainers and in consumers (P <.001) respectively. In multivariable competing risk regression modelling, gs-MELD score (subdistribution hazard ratio: 5.78, 95{\%} CI: 2.17-15.38, P <.001) and recurrent alcohol consumption (subdistribution hazard ratio: 12.18, 95{\%} CI: 3.16-46.95, P <.001) were independently associated with 5-year mortality. Conclusions: Both gs-MELD score and alcohol consumption drive AH long-term prognosis. The gs-MELD score may guide the development of molecularly targeted therapies in AH.",
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T1 - Gene signature-MELD score and alcohol relapse determine long-term prognosis of patients with severe alcoholic hepatitis

AU - Deltenre, Pierre

AU - Trépo, Eric

AU - Fujiwara, Naoto

AU - Goossens, Nicolas

AU - Marot, Astrid

AU - Dubois, Margaux

AU - Spahr, Laurent

AU - Henrion, Jean

AU - Moreno, Christophe

AU - Hoshida, Yujin

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: The gene-signature-model for end stage liver disease (gs-MELD) score has been shown to be a strong predictor of 6-month survival in severe alcoholic hepatitis (AH). Currently, only a few studies have evaluated the long-term prognosis of patients with severe AH. Aim: To assess the prognostic value of the gs-MELD score at 5 years in patients with severe AH. Methods: Forty-eight consecutive patients with AH (25 males, median age 52 years [95% IC: 48-56]) were included. Results: The median gs-MELD score was 2.6 (95% CI: 2.2-3.0). According to the gs-MELD score, 22 patients (46%) were considered to have a poor prognosis. During a median follow-up of 29 months (95% CI: 4-43), 19 patients (40%) were abstinent and 24 patients (50%) died. At 5 years, rates of survival were 61% (95% CI: 41-81) and 26% (95% CI: 11-55) in patients with low and high gs-MELD scores (P =.001), and 81% (95% CI: 58-96) and 22% (95% CI: 10-47) in abstainers and in consumers (P <.001) respectively. In multivariable competing risk regression modelling, gs-MELD score (subdistribution hazard ratio: 5.78, 95% CI: 2.17-15.38, P <.001) and recurrent alcohol consumption (subdistribution hazard ratio: 12.18, 95% CI: 3.16-46.95, P <.001) were independently associated with 5-year mortality. Conclusions: Both gs-MELD score and alcohol consumption drive AH long-term prognosis. The gs-MELD score may guide the development of molecularly targeted therapies in AH.

AB - Background: The gene-signature-model for end stage liver disease (gs-MELD) score has been shown to be a strong predictor of 6-month survival in severe alcoholic hepatitis (AH). Currently, only a few studies have evaluated the long-term prognosis of patients with severe AH. Aim: To assess the prognostic value of the gs-MELD score at 5 years in patients with severe AH. Methods: Forty-eight consecutive patients with AH (25 males, median age 52 years [95% IC: 48-56]) were included. Results: The median gs-MELD score was 2.6 (95% CI: 2.2-3.0). According to the gs-MELD score, 22 patients (46%) were considered to have a poor prognosis. During a median follow-up of 29 months (95% CI: 4-43), 19 patients (40%) were abstinent and 24 patients (50%) died. At 5 years, rates of survival were 61% (95% CI: 41-81) and 26% (95% CI: 11-55) in patients with low and high gs-MELD scores (P =.001), and 81% (95% CI: 58-96) and 22% (95% CI: 10-47) in abstainers and in consumers (P <.001) respectively. In multivariable competing risk regression modelling, gs-MELD score (subdistribution hazard ratio: 5.78, 95% CI: 2.17-15.38, P <.001) and recurrent alcohol consumption (subdistribution hazard ratio: 12.18, 95% CI: 3.16-46.95, P <.001) were independently associated with 5-year mortality. Conclusions: Both gs-MELD score and alcohol consumption drive AH long-term prognosis. The gs-MELD score may guide the development of molecularly targeted therapies in AH.

KW - cirrhosis

KW - MELD

KW - prognosis

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