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dc.contributor.authorBennett, K
dc.contributor.authorEnki, DG
dc.contributor.authorThursz, M
dc.contributor.authorCramp, ME
dc.contributor.authorDhanda, AD
dc.date.accessioned2019-06-25T07:43:38Z
dc.date.available2019-06-25T07:43:38Z
dc.date.issued2019-06-23
dc.identifier.issn0269-2813
dc.identifier.issn1365-2036
dc.identifier.urihttp://hdl.handle.net/10026.1/14429
dc.description.abstract

<jats:title>Summary</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Alcoholic hepatitis is a serious complication of alcohol misuse. Severe alcoholic hepatitis with its high mortality, has been investigated in detail but ‘nonsevere alcoholic hepatitis’ is poorly characterised. Survival of this group of patients is unknown.</jats:p></jats:sec><jats:sec><jats:title>Aim</jats:title><jats:p>To conduct a systematic review and meta‐analysis to determine 28‐day, 90‐day and 1‐year mortality of patients with nonsevere alcoholic hepatitis.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>The protocol was registered on the PROSPERO database (CRD42018107451). Embase, Medline and Cochrane Central databases were searched until July 2018. All study designs reporting mortality rates in patients with nonsevere alcoholic hepatitis were eligible. Mortality data were extracted and meta‐analysis performed using a random effects model. Risk of bias was assessed by Cochrane risk of bias or National Institutes of Health quality assessment tool for case series studies.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Twenty‐five studies (n = 1372 patients; 12 prospective) met criteria. Nonsevere was variably defined based on bilirubin, prothrombin time, and creatinine. Twenty‐eight day mortality (17 studies; n = 993) was 6% (95% CI 3%‐9%; <jats:italic>I</jats:italic><jats:sup>2</jats:sup> = 67.3%; <jats:italic>P</jats:italic> &lt; 0.001), 90‐day mortality (15 studies; n = 755) was 7% (4%‐11%, <jats:italic>I</jats:italic><jats:sup>2</jats:sup> = 64.2%; <jats:italic>P</jats:italic> &lt; 0.001) and 1‐year mortality (five studies; n = 234) was 13% (4%‐24%; <jats:italic>I</jats:italic><jats:sup>2</jats:sup> = 72%; <jats:italic>P</jats:italic> = 0.006). Subgroup analyses by method of diagnosis (histological vs clinical) or study design (prospective vs retrospective) did not reveal differences in mortality.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Nonsevere alcoholic hepatitis is not benign with 6% and 13% 28‐day and 1‐year mortality, respectively. This systematic review demonstrates the paucity of high quality studies in patients with nonsevere alcoholic hepatitis. Our analysis suggests that patients who do not meet criteria for severe alcoholic hepatitis are an important and hitherto overlooked clinical group. Full characterisation of clinical outcome and development of treatment strategies to reduce mortality in this group is a priority.</jats:p></jats:sec>

dc.format.extent249-257
dc.format.mediumPrint-Electronic
dc.languageen
dc.language.isoen
dc.publisherWiley
dc.subjectalcoholic hepatitis
dc.subjectmeta-analysis
dc.subjectmortality
dc.subjectsystematic review
dc.titleSystematic review with meta‐analysis: high mortality in patients with non‐severe alcoholic hepatitis
dc.typejournal-article
dc.typeReview
plymouth.author-urlhttps://www.ncbi.nlm.nih.gov/pubmed/31231848
plymouth.issue3
plymouth.volume50
plymouth.publication-statusPublished
plymouth.journalAlimentary Pharmacology and Therapeutics
dc.identifier.doi10.1111/apt.15376
plymouth.organisational-group/Plymouth
plymouth.organisational-group/Plymouth/Faculty of Health
plymouth.organisational-group/Plymouth/Faculty of Health/Peninsula Medical School
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA/UoA01 Clinical Medicine
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA/UoA01 Clinical Medicine/UoA01 Clinical Medicine
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA/UoA03 Allied Health Professions, Dentistry, Nursing and Pharmacy
plymouth.organisational-group/Plymouth/Research Groups
plymouth.organisational-group/Plymouth/Research Groups/Institute of Health and Community
plymouth.organisational-group/Plymouth/Research Groups/Institute of Translational and Stratified Medicine (ITSMED)
plymouth.organisational-group/Plymouth/Research Groups/Institute of Translational and Stratified Medicine (ITSMED)/CBBB
plymouth.organisational-group/Plymouth/Research Groups/Institute of Translational and Stratified Medicine (ITSMED)/CBR
plymouth.organisational-group/Plymouth/Research Groups/Plymouth Institute of Health and Care Research (PIHR)
plymouth.organisational-group/Plymouth/Users by role
plymouth.organisational-group/Plymouth/Users by role/Academics
dc.publisher.placeEngland
dcterms.dateAccepted2019-05-26
dc.rights.embargodate2020-6-22
dc.identifier.eissn1365-2036
dc.rights.embargoperiodNot known
rioxxterms.funderMedical Research Council
rioxxterms.identifier.projectMICA: Minimising Mortality from Alcoholic Hepatitis
rioxxterms.versionofrecord10.1111/apt.15376
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.licenseref.startdate2019-06-23
rioxxterms.typeJournal Article/Review
plymouth.funderMICA: Minimising Mortality from Alcoholic Hepatitis::Medical Research Council


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