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

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dc.contributor.authorSkladaný, Ľubomír
dc.contributor.authorŽilinčanová, Daniela
dc.contributor.authorKubánek, Natália
dc.contributor.authorAdamcová - Selčanová, Svetlana
dc.contributor.authorHavaj, Daniel Ján
dc.contributor.authorLafférs, Lukáš
dc.contributor.authorŽilinčan, Michal
dc.contributor.authorIslam, Alvi Husni
dc.contributor.authorArab, Juan-Pablo
dc.contributor.authorKoller, Tomáš
dc.date.accessioned2025-03-25T06:57:41Z
dc.date.available2025-03-25T06:57:41Z
dc.date.issued2025
dc.descriptionIn: Alcohol and alcoholism. Oxford : Oxford University Press, 2025. ISSN 0735-0414. Vol. 60, no. 2 (2025), pp. 1-11.
dc.description.abstractBackground 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.
dc.identifier.doihttps://doi.org/10.1093/alcalc/agae092
dc.identifier.issn0735-0414
dc.identifier.urihttps://repo.umb.sk/handle/123456789/254
dc.language.isoen
dc.publisherOxford : Oxford University Press
dc.rightsCC BY Creative Commons Attribution („uvedenie autora“) 4.0.
dc.rightsinfo:eu-repo/semantics/openAccess
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectalcohol-associated hepatitis
dc.subjectsurvival
dc.subjecttime
dc.subjectprognosis
dc.subjecttertiary care
dc.subjectsecondary care
dc.subjectbundle of care
dc.subjectadvanced chronic liver disease
dc.subjectcirrhosis
dc.subjectacute decompensation
dc.subjecttrigger
dc.titleProspective study on time-to-tertiary care in alcohol-associated hepatitis: space-time coordinates as prognostic tool and therapeutic target
dc.typeArticle
dc.typeinfo:eu-repo/semantics/article

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