LAUSR

BACKGROUND AND AIMS Patients with alcoholic hepatitis and a modified Maddrey's discriminant function (mDF) <32 have a low risk of short-term mortality. However, few data exist concerning long-term outcomes. The aims of this study were to evaluate 5-year survival rates and to identify predictive factors for long-term prognosis in this patient population. METHODS We studied patients from 2 centres who were admitted for hepatic decompensation (ascites, hepatic encephalopathy, or jaundice) and who had histological findings of steatohepatitis and an mDF <32. Clinical and biological parameters were recorded at the time of liver biopsy and alcohol consumption was recorded during follow-up. We performed Cox proportional hazard survival analysis to identify factors associated with 5-year survival. RESULTS One hundred and twenty-one patients were included (male: 64%, mean age: 51.5±10.3 years, presence of cirrhosis: 84%). The median MELD and mDF scores were 14 [25th-75th percentile: 11.7-16.1] and 19 [25th-75th percentile: 11.1-24], respectively. During follow-up, 30% of the patients remained abstinent. Survival rates at 1, 6, 12, 24, and 60 months were 96.7±1.6%, 90.1±2.7%, 80.8±3.6%, 69.9±4.3%, and 50.7±4.9%, respectively. The majority of deaths (80%) were liver-related. In multivariable analysis, encephalopathy at baseline and alcohol abstinence were predictive of 5-year survival. The 5-year survival rates of patients without and with encephalopathy at baseline were 60.5±5.8% and 29.7±8%, respectively, and the 5-year survival rates of abstinent and non-abstinent patients were 74.8± 8% and 40.9±.8%, respectively. CONCLUSIONS Mortality of patients with alcoholic hepatitis and an mDF <32 presenting with an acute decompensation is around 50% at 5 years. Hepatic encephalopathy at baseline and lack of alcohol abstinence impair long-term prognosis. New treatment strategies, including measures to ensure abstinence, are required.