New strategies in management of severe alcoholic hepatitis
Aim of investigation. To evaluate efficacy and safety of S-adenosyl-L-methionine for treatment of alcohol-induced hepatitis of high severity.Material and methods. Overall 40 patients with severe alcoholic hepatitis from two medical centers were selected for the study. Patients were randomly divided...
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| Main Authors: | , , , |
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| Format: | Article |
| Language: | Russian |
| Published: |
Gastro LLC
2015-10-01
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| Series: | Российский журнал гастроэнтерологии, гепатологии, колопроктологии |
| Subjects: | |
| Online Access: | https://www.gastro-j.ru/jour/article/view/1069 |
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| Summary: | Aim of investigation. To evaluate efficacy and safety of S-adenosyl-L-methionine for treatment of alcohol-induced hepatitis of high severity.Material and methods. Overall 40 patients with severe alcoholic hepatitis from two medical centers were selected for the study. Patients were randomly divided in two groups. The first group included 20 patients (16 men, 4 women, mean age 46,85±11,89 years). Median daily alcohol consumption — 71 years, 25-th and 75-th percentiles — 45,5 and 92,0 years respectively, duration of intake — 16,85±13,32 year. The mean score of Maddrey index (MI) was 58,5±26,8. The second group included 20 patients as well (11 men and 9 women, mean age — 46,10±10,47 years). The median of alcohol consumption per day was 73,8 years, 25-th and 75-th percentiles — 64,25 and 80,0 years respectively, duration of use — 16,25±5,18 year. The mean MI was 79,6±18,7. Groups were comparable by basic clinical and laboratory features. Patients of the first group received prednisolone 40 mg/day orally, patients of the second group received combination of prednisolone 40 mg/day orally and S-adenosyl-L-methionine (Adomet) 800 mg/day as intravenous infusions for 7 days, followed by 400 mg tid orally up to the 28 day of treatment. Lille index was utilized as treatment response criterion. During statistical data analysis Wilcoxon, Manna– Whitney and chi-square criteria were used. The survival analysis was done using Kaplan–Meyer curve with Breslow and LogRank significance estimation.Results. Treatment response was higher in the group of patients receiving prednisolone in combination to Adomet (95 and 65% respectively, р=0,018). In this group the trend to increase survival was marked in comparison to the group receiving prednisolone monotherapy (100 and 90%). The rate of adverse events did not differ (р=0,50) significantly between two groups. Hepatorenal syndrome was significantly more frequent in patients receiving prednisolone (20 and 0%, р=0,03).Conclusions. Prescription of prednisolone and Adomet combination at severe alcohol-induced hepatitis increases the treatment response rate to corticosteroids, promotes decrease of short-term mortality and results in significantly less frequent development of hepatorenal syndrome as compared to standard therapy. |
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| ISSN: | 1382-4376 2658-6673 |