AARC score determines outcomes in patients with alcohol-associated hepatitis: a multinational study

Rakhi Maiwall; Samba Siva Rao Pasupuleti; Ashok Choudhury; Dong Joon kim; Ajit Sood; Omesh Goyal; Vandana Midha; Harshad Devarbhavi; Anil Arora; Ashish Kumar; Manoj Kumar Sahu; Sudhir Maharshi; Ajay Kumar Duseja; Virendra Singh; Sunil Taneja; P. N. Rao; Anand Kulkarni; Hasmik Ghazinian; Saeed Hamid; C. E. Eapen; Ashish Goel; Ananta Shreshtha; Samir Shah; Jinhua Hu; V. G.Mohan Prasad; Nan Yuemin; Xin Shaojie; R. K. Dhiman; Tao Chen; Qin Ning; Charles Panackel; Madunil A. Niriella; Thupten Kelsang Lama; Soek Siam Tan; A. Kadir Dokmeci; Akash Shukla; Manoj Kumar Sharma; Shiv Kumar Sarin

doi:10.1007/s12072-022-10463-z

AARC score determines outcomes in patients with alcohol-associated hepatitis: a multinational study

Rakhi Maiwall, Samba Siva Rao Pasupuleti, Ashok Choudhury, Dong Joon kim, Ajit Sood, Omesh Goyal, Vandana Midha, Harshad Devarbhavi, Anil Arora, Ashish Kumar, Manoj Kumar Sahu, Sudhir Maharshi, Ajay Kumar Duseja, Virendra Singh, Sunil Taneja, P. N. Rao, Anand Kulkarni, Hasmik Ghazinian, Saeed Hamid, C. E. EapenAshish Goel, Ananta Shreshtha, Samir Shah, Jinhua Hu, V. G.Mohan Prasad, Nan Yuemin, Xin Shaojie, R. K. Dhiman, Tao Chen, Qin Ning, Charles Panackel, Madunil A. Niriella, Thupten Kelsang Lama, Soek Siam Tan, A. Kadir Dokmeci, Akash Shukla, Manoj Kumar Sharma, Shiv Kumar Sarin

Department of Medicine, Medical College, Pakistan

Research output: Contribution to journal › Article › peer-review

9 Citations (Scopus)

Abstract

Background and aim: Acute-on-chronic liver failure (ACLF) is a severe form of alcoholic hepatitis (SAH). We aimed to study the natural course, response to corticosteroids (CS), and the role of the Asian Pacific Association for the Study of Liver (APASL) research consortium (AARC) score in determining clinical outcomes in AH patients. Methods: Prospectively collected data from the AARC database were analyzed. Results: Of the 1249 AH patients, (aged 43.8 ± 10.6 years, 96.9% male, AARC score 9.2 ± 1.9), 38.8% died on a 90 day follow-up. Of these, 150 (12.0%) had mild–moderate AH (MAH), 65 (5.2%) had SAH and 1034 (82.8%) had ACLF. Two hundred and eleven (16.9%) patients received CS, of which 101 (47.87%) were steroid responders by day 7 of Lille’s model, which was associated with improved survival [Hazard ratio (HR) 0.15, 95% CI 0.12–0.19]. AARC-ACLF grade 3 [OR 0.28, 0.14–0.55] was an independent predictor of steroid non-response and mortality [HR 3.29, 2.63–4.11]. Complications increased with degree of liver failure [AARC grade III vs. II vs I], bacterial infections [48.6% vs. 37% vs. 34.7%; p < 0.001); extrahepatic organ failure [66.9% vs. 41.8% vs. 35.4%; p < 0.001] respectively. The AARC score better discriminated 90-day mortality. Harrell’s C-index was 0.72 compared to other scores. Conclusion: Nearly 4 of 5 patients with AH present with ACLF. Such patients have a higher risk of infections, organ failures, lower response to CS, and higher mortality. Patients with AH and ACLF with AARC grade 3 should be considered for an early liver transplant.

Original language	English
Pages (from-to)	662-675
Number of pages	14
Journal	Hepatology International
Volume	17
Issue number	3
DOIs	https://doi.org/10.1007/s12072-022-10463-z
Publication status	Published - Jun 2023

Keywords

A.K.I
AARC
Ascites
Portal hypertension
SIRS

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1007/s12072-022-10463-z

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Maiwall, R., Pasupuleti, S. S. R., Choudhury, A., kim, D. J., Sood, A., Goyal, O., Midha, V., Devarbhavi, H., Arora, A., Kumar, A., Sahu, M. K., Maharshi, S., Duseja, A. K., Singh, V., Taneja, S., Rao, P. N., Kulkarni, A., Ghazinian, H., Hamid, S., ... Sarin, S. K. (2023). AARC score determines outcomes in patients with alcohol-associated hepatitis: a multinational study. Hepatology International, 17(3), 662-675. https://doi.org/10.1007/s12072-022-10463-z

@article{0e2dc0cc7e8045d294d2c382c7ae29f1,

title = "AARC score determines outcomes in patients with alcohol-associated hepatitis: a multinational study",

abstract = "Background and aim: Acute-on-chronic liver failure (ACLF) is a severe form of alcoholic hepatitis (SAH). We aimed to study the natural course, response to corticosteroids (CS), and the role of the Asian Pacific Association for the Study of Liver (APASL) research consortium (AARC) score in determining clinical outcomes in AH patients. Methods: Prospectively collected data from the AARC database were analyzed. Results: Of the 1249 AH patients, (aged 43.8 ± 10.6 years, 96.9% male, AARC score 9.2 ± 1.9), 38.8% died on a 90 day follow-up. Of these, 150 (12.0%) had mild–moderate AH (MAH), 65 (5.2%) had SAH and 1034 (82.8%) had ACLF. Two hundred and eleven (16.9%) patients received CS, of which 101 (47.87%) were steroid responders by day 7 of Lille{\textquoteright}s model, which was associated with improved survival [Hazard ratio (HR) 0.15, 95% CI 0.12–0.19]. AARC-ACLF grade 3 [OR 0.28, 0.14–0.55] was an independent predictor of steroid non-response and mortality [HR 3.29, 2.63–4.11]. Complications increased with degree of liver failure [AARC grade III vs. II vs I], bacterial infections [48.6% vs. 37% vs. 34.7%; p < 0.001); extrahepatic organ failure [66.9% vs. 41.8% vs. 35.4%; p < 0.001] respectively. The AARC score better discriminated 90-day mortality. Harrell{\textquoteright}s C-index was 0.72 compared to other scores. Conclusion: Nearly 4 of 5 patients with AH present with ACLF. Such patients have a higher risk of infections, organ failures, lower response to CS, and higher mortality. Patients with AH and ACLF with AARC grade 3 should be considered for an early liver transplant.",

keywords = "A.K.I, AARC, Ascites, Portal hypertension, SIRS",

author = "Rakhi Maiwall and Pasupuleti, {Samba Siva Rao} and Ashok Choudhury and kim, {Dong Joon} and Ajit Sood and Omesh Goyal and Vandana Midha and Harshad Devarbhavi and Anil Arora and Ashish Kumar and Sahu, {Manoj Kumar} and Sudhir Maharshi and Duseja, {Ajay Kumar} and Virendra Singh and Sunil Taneja and Rao, {P. N.} and Anand Kulkarni and Hasmik Ghazinian and Saeed Hamid and Eapen, {C. E.} and Ashish Goel and Ananta Shreshtha and Samir Shah and Jinhua Hu and Prasad, {V. G.Mohan} and Nan Yuemin and Xin Shaojie and Dhiman, {R. K.} and Tao Chen and Qin Ning and Charles Panackel and Niriella, {Madunil A.} and Lama, {Thupten Kelsang} and Tan, {Soek Siam} and Dokmeci, {A. Kadir} and Akash Shukla and Sharma, {Manoj Kumar} and Sarin, {Shiv Kumar}",

note = "Publisher Copyright: {\textcopyright} 2022, Asian Pacific Association for the Study of the Liver.",

year = "2023",

month = jun,

doi = "10.1007/s12072-022-10463-z",

language = "English",

volume = "17",

pages = "662--675",

journal = "Hepatology International",

issn = "1936-0533",

publisher = "Springer New York",

number = "3",

}

Maiwall, R, Pasupuleti, SSR, Choudhury, A, kim, DJ, Sood, A, Goyal, O, Midha, V, Devarbhavi, H, Arora, A, Kumar, A, Sahu, MK, Maharshi, S, Duseja, AK, Singh, V, Taneja, S, Rao, PN, Kulkarni, A, Ghazinian, H, Hamid, S, Eapen, CE, Goel, A, Shreshtha, A, Shah, S, Hu, J, Prasad, VGM, Yuemin, N, Shaojie, X, Dhiman, RK, Chen, T, Ning, Q, Panackel, C, Niriella, MA, Lama, TK, Tan, SS, Dokmeci, AK, Shukla, A, Sharma, MK & Sarin, SK 2023, 'AARC score determines outcomes in patients with alcohol-associated hepatitis: a multinational study', Hepatology International, vol. 17, no. 3, pp. 662-675. https://doi.org/10.1007/s12072-022-10463-z

TY - JOUR

T1 - AARC score determines outcomes in patients with alcohol-associated hepatitis

T2 - a multinational study

AU - Maiwall, Rakhi

AU - Pasupuleti, Samba Siva Rao

AU - Choudhury, Ashok

AU - kim, Dong Joon

AU - Sood, Ajit

AU - Goyal, Omesh

AU - Midha, Vandana

AU - Devarbhavi, Harshad

AU - Arora, Anil

AU - Kumar, Ashish

AU - Sahu, Manoj Kumar

AU - Maharshi, Sudhir

AU - Duseja, Ajay Kumar

AU - Singh, Virendra

AU - Taneja, Sunil

AU - Rao, P. N.

AU - Kulkarni, Anand

AU - Ghazinian, Hasmik

AU - Hamid, Saeed

AU - Eapen, C. E.

AU - Goel, Ashish

AU - Shreshtha, Ananta

AU - Shah, Samir

AU - Hu, Jinhua

AU - Prasad, V. G.Mohan

AU - Yuemin, Nan

AU - Shaojie, Xin

AU - Dhiman, R. K.

AU - Chen, Tao

AU - Ning, Qin

AU - Panackel, Charles

AU - Niriella, Madunil A.

AU - Lama, Thupten Kelsang

AU - Tan, Soek Siam

AU - Dokmeci, A. Kadir

AU - Shukla, Akash

AU - Sharma, Manoj Kumar

AU - Sarin, Shiv Kumar

PY - 2023/6

Y1 - 2023/6

N2 - Background and aim: Acute-on-chronic liver failure (ACLF) is a severe form of alcoholic hepatitis (SAH). We aimed to study the natural course, response to corticosteroids (CS), and the role of the Asian Pacific Association for the Study of Liver (APASL) research consortium (AARC) score in determining clinical outcomes in AH patients. Methods: Prospectively collected data from the AARC database were analyzed. Results: Of the 1249 AH patients, (aged 43.8 ± 10.6 years, 96.9% male, AARC score 9.2 ± 1.9), 38.8% died on a 90 day follow-up. Of these, 150 (12.0%) had mild–moderate AH (MAH), 65 (5.2%) had SAH and 1034 (82.8%) had ACLF. Two hundred and eleven (16.9%) patients received CS, of which 101 (47.87%) were steroid responders by day 7 of Lille’s model, which was associated with improved survival [Hazard ratio (HR) 0.15, 95% CI 0.12–0.19]. AARC-ACLF grade 3 [OR 0.28, 0.14–0.55] was an independent predictor of steroid non-response and mortality [HR 3.29, 2.63–4.11]. Complications increased with degree of liver failure [AARC grade III vs. II vs I], bacterial infections [48.6% vs. 37% vs. 34.7%; p < 0.001); extrahepatic organ failure [66.9% vs. 41.8% vs. 35.4%; p < 0.001] respectively. The AARC score better discriminated 90-day mortality. Harrell’s C-index was 0.72 compared to other scores. Conclusion: Nearly 4 of 5 patients with AH present with ACLF. Such patients have a higher risk of infections, organ failures, lower response to CS, and higher mortality. Patients with AH and ACLF with AARC grade 3 should be considered for an early liver transplant.

AB - Background and aim: Acute-on-chronic liver failure (ACLF) is a severe form of alcoholic hepatitis (SAH). We aimed to study the natural course, response to corticosteroids (CS), and the role of the Asian Pacific Association for the Study of Liver (APASL) research consortium (AARC) score in determining clinical outcomes in AH patients. Methods: Prospectively collected data from the AARC database were analyzed. Results: Of the 1249 AH patients, (aged 43.8 ± 10.6 years, 96.9% male, AARC score 9.2 ± 1.9), 38.8% died on a 90 day follow-up. Of these, 150 (12.0%) had mild–moderate AH (MAH), 65 (5.2%) had SAH and 1034 (82.8%) had ACLF. Two hundred and eleven (16.9%) patients received CS, of which 101 (47.87%) were steroid responders by day 7 of Lille’s model, which was associated with improved survival [Hazard ratio (HR) 0.15, 95% CI 0.12–0.19]. AARC-ACLF grade 3 [OR 0.28, 0.14–0.55] was an independent predictor of steroid non-response and mortality [HR 3.29, 2.63–4.11]. Complications increased with degree of liver failure [AARC grade III vs. II vs I], bacterial infections [48.6% vs. 37% vs. 34.7%; p < 0.001); extrahepatic organ failure [66.9% vs. 41.8% vs. 35.4%; p < 0.001] respectively. The AARC score better discriminated 90-day mortality. Harrell’s C-index was 0.72 compared to other scores. Conclusion: Nearly 4 of 5 patients with AH present with ACLF. Such patients have a higher risk of infections, organ failures, lower response to CS, and higher mortality. Patients with AH and ACLF with AARC grade 3 should be considered for an early liver transplant.

KW - A.K.I

KW - AARC

KW - Ascites

KW - Portal hypertension

KW - SIRS

UR - http://www.scopus.com/inward/record.url?scp=85144851622&partnerID=8YFLogxK

U2 - 10.1007/s12072-022-10463-z

DO - 10.1007/s12072-022-10463-z

M3 - Article

C2 - 36571711

AN - SCOPUS:85144851622

SN - 1936-0533

VL - 17

SP - 662

EP - 675

JO - Hepatology International

JF - Hepatology International

IS - 3

ER -

AARC score determines outcomes in patients with alcohol-associated hepatitis: a multinational study

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Keywords

UN SDGs

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