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• W2793793753 abstract "We welcome the correspondence from Sandahl et al. regarding prediction of outcome in alcoholic hepatitis. They highlight the limitation of prognostic scores such as the Glasgow Alcoholic Hepatitis Score (GAHS) in the prediction of long-term survival (>2 years) after a presentation with alcoholic hepatitis. [1] Sandahl T.D. Vilsrup H. Jepson P. The long-term prognosis of alcoholic hepatitis is poor and independent of disease severity for patients surviving an acute episode. J Hepatol. 2018; 68: 1330-1331 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar This is similar to previous observations which have shown that such scores had very poor predictive discriminative ability a year after the initial illness. [2] Potts J.R. Goubet S. Heneghen M.A. Verma S. Determinants of long-term outcome in severe alcoholic hepatitis. Aliment Pharmacol Ther. 2013; 38: 584-595 Crossref PubMed Scopus (88) Google Scholar The inadequacy of these prognostic scores in predicting long-term outcome is to be expected. Alcoholic hepatitis is an acute florid inflammatory manifestation of alcoholic liver disease with a relatively high short-term mortality. The purpose of the GAHS is to assess the acute stage of alcoholic hepatitis and to inform immediate clinical treatment decisions: it was never designed to predict subsequent long-term outcome in short-term survivors. 3 Forrest E.H. Evans C.D.J. Stewart S. Phillips M. Oo Y.H. McAvoy N. et al. Analysis of factors related to mortality in alcoholic hepatitis and the derivation and validation of the Glasgow alcoholic hepatitis score. Gut. 2005; 54: 1179 Crossref Scopus (302) Google Scholar , 4 Forrest E.H. Morris A.J. Stewart S. Phillips M. Oo Y.H. Fischer N.C. et al. The Glasgow alcoholic hepatitis score identifies patients who may benefit from corticosteroids. Gut. 2007; 56: 1743-1746 Crossref PubMed Scopus (105) Google Scholar The outcome of patients who survive more than three months after presentation with alcoholic hepatitis is determined by factors other than the degree of initial liver injury. Return to continued alcohol ingestion is perhaps the most significant of these, [5] Louvet A. Labreuche J. Artu A. Bouthers A. Rolland B. Saffers P. et al. Main drivers of outcome differ between short term and long term in severe alcoholic hepatitis: A prospective study. Hepatology. 2017; 66: 1464-1473 Crossref PubMed Scopus (103) Google Scholar although other factors including genetics may play a role. [6] Atkinson S.R. Way M.J. McQuillin A. Morgan M.Y. Thursz M.R. Homozygosity for rs738409: G in PNPLA3 is associated with increased mortality following an episode of severe alcoholic hepatitis. J Hepatol. 2017; 67: 120-127 Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar The long-term prognosis of alcoholic hepatitis is poor and independent of disease severity for patients surviving an acute episodeJournal of HepatologyVol. 68Issue 6PreviewWe read with interest the paper by Forrest et al. on prognostic scores in alcoholic hepatitis (AH) based on the large prospective STOPAH trial of 1,068 patients.1 Full-Text PDF Application of prognostic scores in the STOPAH trial: Discriminant function is no longer the optimal scoring system in alcoholic hepatitisJournal of HepatologyVol. 68Issue 3PreviewAlcoholic hepatitis is an acute manifestation of alcoholic liver disease with high short and medium-term mortality.1 Recognition of those at risk of a poor outcome is fundamental to structuring patient management. Several prognostic scores have been developed to predict the course of alcoholic hepatitis. However, to be useful in a clinical context, scores should not only identify patients with a poor prognosis but also direct patient care.2 Full-Text PDF" @default.
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• W2793793753 date "2018-06-01" @default.
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• W2793793753 title "Reply to: “The long-term prognosis of alcoholic hepatitis is poor and independent of disease severity for patients surviving an acute episode”" @default.
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• W2793793753 doi "https://doi.org/10.1016/j.jhep.2018.02.023" @default.
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