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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2017; 23(11): 2052-2059
Published online Mar 21, 2017. doi: 10.3748/wjg.v23.i11.2052
Published online Mar 21, 2017. doi: 10.3748/wjg.v23.i11.2052
Infection does not increase long-term mortality in patients with acute severe alcoholic hepatitis treated with corticosteroids
Ashwin D Dhanda, Matthew E Cramp, Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth PL6 8BU, United Kingdom
Ashwin D Dhanda, Matthew E Cramp, South West Liver Unit, Plymouth Hospitals NHS Trust, Plymouth PL6 8DH, United Kingdom
Ashwin D Dhanda, Ashish Sinha, Vicky Hunt, Sarah Saleem, Peter L Collins, Department of Liver Medicine, University Hospitals Bristol NHS Foundation Trust, Bristol BS2 8HW, United Kingdom
Author contributions: Dhanda AD and Collins PL conceived and designed the study; Dhanda AD, Sinha A, Hunt V and Saleem S collected data; Dhanda AD conducted data analysis and drafted manuscript; Cramp ME and Collins PL edited, reviewed and approved the final article.
Institutional review board statement: This study was conducted in accordance with the principles of the Declaration of Helsinki and was prospectively approved by the National Health Service Health Research Authority (reference: 07/Q2007/09).
Informed consent statement: Written informed consent was obtained from participants or, where they lacked capacity, assent was obtained from a personal or nominated consultee.
Conflict-of-interest statement: Cramp ME is an advisory board member for Abbvie, Gilead, MSD and BMS. Collins PL is an advisory board member for Bayer and Intercept.
Data sharing statement: The dataset is available from the corresponding author on request.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ashwin D Dhanda, BSc (Hons), MBChB, MRCP, PhD, Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, John Bull Building, Research Way, Plymouth PL6 8BU, United Kingdom. ashwin.dhanda@plymouth.ac.uk
Telephone: +44-1752-432722 Fax: +44-1752-517576
Received: December 9, 2016
Peer-review started: December 9, 2016
First decision: December 29, 2016
Revised: January 6, 2017
Accepted: February 17, 2017
Article in press: February 17, 2017
Published online: March 21, 2017
Peer-review started: December 9, 2016
First decision: December 29, 2016
Revised: January 6, 2017
Accepted: February 17, 2017
Article in press: February 17, 2017
Published online: March 21, 2017
Core Tip
Core tip: Corticosteroids are the only treatment shown to improve outcome in patients with acute severe alcoholic hepatitis (AAH) but may be associated with increased rates of infection and mortality. In this prospective cohort study of patients with AAH treated with corticosteroids rates of clinically relevant infections were accurately documented. Half of the study participants developed an infection during their hospitalisation with the commonest sites being ascites and bacteraemia. Infection was associated with higher creatinine, model for end-stage liver disease and lille score but not with higher 90-d or 1 year mortality. Infection is common in patients with AAH but is not associated with increased mortality.