Prospective study on time-to-tertiary care in alcohol-associated hepatitis: space-time coordinates as prognostic tool and therapeutic target

Obrázok miniatúry

Súbory

(1.18 MB)

Dátum

2025

Autori

Názov časopisu

ISSN časopisu

Názov zväzku

Vydavateľ

Oxford : Oxford University Press

ISBN

ISSN

0735-0414

Abstrakt

Background and aims: Alcohol-associated hepatitis (AH) frequently triggers acute decompensation (AD) in cirrhosis, with severe AH linked to high short-term mortality, especially in acute-on-chronic liver failure. Current corticosteroid treatments have limited efficacy, highlighting the need for new therapies. We hypothesized that severe AH outcomes are influenced by early specialized care; thus, we examined the impact of time-to-tertiary care (TTTc). Methods: Adults with cirrhosis or advanced chronic liver disease were enrolled (RH7, NCT04767945). AH was diagnosed using National Institute on Alcohol Abuse and Alcoholism criteria. Primary admission site, TTTc, and adverse outcomes (death or liver transplantation) were analyzed. Patients admitted directly to tertiary care were assigned a TTTc of zero.Results: Of 221 AD-AH patients, 107 were transferred from secondary care to tertiary care (TTTc >0) and 114 were admitted directly (TTTc = 0). TTTc >0 patients were younger (48.3 vs. 52 years, P = .008) and had more severe disease, as shown by model for end-stage liver disease scores (25.5 vs. 20.8, P < .001) and Maddrey’s discriminant function (59.3 vs. 40.6, P < .001). Propensity-score matching yielded 49 case pairs. The Cox model showed that transfer from secondary care was not associated with increased risk, but delayed transfer (days, hazard ratio = 1.03, 95% confidence interval 1.01–1.05) independently predicted adverse outcomes. Conclusions: Delayed initiation of specialized care adversely impacts outcomes in AD-AH. If validated, timely care bundles could improve AH survival, similar to sepsis or vascular syndromes.

Popis

In: Alcohol and alcoholism. Oxford : Oxford University Press, 2025. ISSN 0735-0414. Vol. 60, no. 2 (2025), pp. 1-11.

Kľúčové slová

alcohol-associated hepatitis, survival, time, prognosis, tertiary care, secondary care, bundle of care, advanced chronic liver disease, cirrhosis, acute decompensation, trigger

Výstup z projektu

Citácia

DOI

https://doi.org/10.1093/alcalc/agae092

URI

https://repo.umb.sk/handle/123456789/254

Práva a licenčné podmienky

CC BY Creative Commons Attribution („uvedenie autora“) 4.0.
info:eu-repo/semantics/openAccess

Kolekcie

08 Články v časopisoch