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Tytuł pozycji:

A Combination of N-Acetylcysteine and Prednisone Has No Benefit Over Prednisone Alone in Severe Alcoholic Hepatitis: A Retrospective Analysis.

Tytuł:
A Combination of N-Acetylcysteine and Prednisone Has No Benefit Over Prednisone Alone in Severe Alcoholic Hepatitis: A Retrospective Analysis.
Autorzy:
Amjad W; Institute of Digestive Heath and Liver Diseases, Mercy Medical Center, Baltimore, MD, 21202, USA.
Alukal J; Institute of Digestive Heath and Liver Diseases, Mercy Medical Center, Baltimore, MD, 21202, USA.
Doycheva I; Institute of Digestive Heath and Liver Diseases, Mercy Medical Center, Baltimore, MD, 21202, USA.
Zhang T; Institute of Digestive Heath and Liver Diseases, Mercy Medical Center, Baltimore, MD, 21202, USA.
Maheshwari A; Institute of Digestive Heath and Liver Diseases, Mercy Medical Center, Baltimore, MD, 21202, USA.; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
Yoo H; Institute of Digestive Heath and Liver Diseases, Mercy Medical Center, Baltimore, MD, 21202, USA.
Thuluvath PJ; Institute of Digestive Heath and Liver Diseases, Mercy Medical Center, Baltimore, MD, 21202, USA. .; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA. .
Źródło:
Digestive diseases and sciences [Dig Dis Sci] 2020 Dec; Vol. 65 (12), pp. 3726-3733. Date of Electronic Publication: 2020 Feb 18.
Typ publikacji:
Journal Article
Język:
English
Imprint Name(s):
Publication: 2005- : New York, NY : Springer Science + Business Media
Original Publication: New York, Plenum Pub. Corp.
MeSH Terms:
Acetylcysteine*/administration & dosage
Acetylcysteine*/adverse effects
Hepatitis, Alcoholic*/complications
Hepatitis, Alcoholic*/diagnosis
Hepatitis, Alcoholic*/drug therapy
Hepatitis, Alcoholic*/mortality
Liver Cirrhosis*/diagnosis
Liver Cirrhosis*/etiology
Prednisone*/administration & dosage
Prednisone*/adverse effects
Adult ; Anti-Inflammatory Agents/administration & dosage ; Anti-Inflammatory Agents/adverse effects ; Drug Monitoring/methods ; Drug Therapy, Combination/methods ; Female ; Free Radical Scavengers/administration & dosage ; Free Radical Scavengers/adverse effects ; Humans ; Male ; Outcome and Process Assessment, Health Care ; Renal Insufficiency/diagnosis ; Renal Insufficiency/etiology ; Survival Analysis ; United States/epidemiology
References:
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Contributed Indexing:
Keywords: Alcoholic hepatitis; Child–Pugh score; Combination treatment with NAC and prednisone; Discriminant function; Glasgow alcoholic hepatitis score; Lille score; Model for end-stage liver diseases; N-acetylcysteine; Prednisone; Renal insufficiency
Substance Nomenclature:
0 (Anti-Inflammatory Agents)
0 (Free Radical Scavengers)
VB0R961HZT (Prednisone)
WYQ7N0BPYC (Acetylcysteine)
Entry Date(s):
Date Created: 20200220 Date Completed: 20210204 Latest Revision: 20210204
Update Code:
20240105
DOI:
10.1007/s10620-020-06142-4
PMID:
32072435
Czasopismo naukowe
Introduction: In this study, we assessed whether there were any survival advantages with a combination treatment of intravenous N-acetylcysteine (NAC) and prednisone over prednisone alone in those with severe alcoholic hepatitis [discriminant function (DF) ≥ 32].
Patients and Methods: Between January 1, 2013, and February 28, 2019, we identified 68 patients (mean age 47.2 years ± 10.1, 57% women, 65% cirrhosis, MELD score 28.1 ± 6.6) with alcoholic hepatitis, and of those, 21 (31%) received prednisone and 47 (69%) received prednisone + NAC. Lille score ≥ 0.45 was considered a poor response. Renal insufficiency was defined as GFR < 60 ml/min/1.73m 2 calculated on two separate occasions.
Results: DF (74.2 ± 33.6 vs. 56.9 ± 15.9, p = 0.09) was similar, but MELD (29.2 ± 6.3 vs. 25.5 ± 6.4, p = 0.03) scores were higher in the combination group. The overall 30-day and 90-day mortality was 13.2% (9/68) and 20.6% (14/68), respectively. Women were more likely (OR 4.86, 95% CI 1.62-14.59) to respond to treatment based on Lille score compared to men, but the type of treatment regimen had no effect on Lille score (OR 0.84, 95% CI 0.25-2.78). Treatment regimen had no effect on both adjusted and unadjusted survivals. Multivariate analysis, after adjusting for confounding variables, confirmed these observations. DF + renal insufficiency had the highest AUROC (0.86) to predict mortality.
Conclusion: The combination treatment of NAC + prednisone is not better than prednisone alone in patients with severe alcoholic hepatitis.
Comment in: Dig Dis Sci. 2020 Dec;65(12):3431-3433. (PMID: 32270305)

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