MORTALITY TRENDS AND RISK FACTORS IN ALCOHOL-ASSOCIATED HEPATITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Résumé fourni par la source

Severe alcohol-associated hepatitis (sAH) is a life-threatening condition with high short-term mortality. Despite therapeutic advances, long-term effectiveness remains limited. We conducted a systematic review and meta-analysis to evaluate mortality trends in sAH over the past five decades. We searched PubMed, EMBASE, and Scopus through February 2024 for studies reporting 28-, 60-, and 90-day mortality in sAH. Pooled mortality estimates were calculated using mixed-effects models. Heterogeneity was assessed using the I 2 statistic, with subgroup and meta-regression analyses exploring potential modifiers. Bayesian models estimated the posterior probability distribution of mortality. Forty-five studies comprising 5,632 patients were included. Pooled mortality was 28.3% (95% CI: 22.5–34.8%) at 28 days, 38.3% (95% CI: 31.5–45.5%) at 60 days, and 48.7% (95% CI: 39.2–58.3%) at 90 days. Heterogeneity across studies was high (I 2 > 80%). Bayesian models suggested a decline in 28-day mortality from over 50% in the 1970s to approximately 25% after 2000; however, no consistent reduction in overall mortality was observed. Meta-regression showed no significant association with sex, age, mDF, or publication year, but higher MELD scores were linked to increased mortality (β = +0.20 per point; 95% CI: +0.01 to +0.39; p = 0.037). The use of corticosteroids, NAC, or G-CSF did not significantly affect mortality. Despite improved supportive care, short-term mortality in sAH remains high and unchanged over recent decades. These findings underscore the urgent need for effective treatments and support early liver transplant consideration in selected patients.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.