PhD Scientific Days 2020

Clinical Medicine III. Posters

Inflammatory Profile Characterization and 90-Day Mortality Prediction in a Randomized Clinical Trial of Severe Alcoholic Hepatitis

Előadó neve

Dr. Tornai, Dávid

Előadó munkahelye

University of Debrecen, Clinical Center, Department of Laboratory Medicine

Előadó telefonszáma

+36305409350

Előadó e-mail címe

tornai.david@med.unideb.hu

Az előadás címe

Inflammatory Profile Characterization and 90-Day Mortality Prediction in a Randomized Clinical Trial of Severe Alcoholic Hepatitis

Szerző(k) neve és munkahelye

David Tornai1a,b, Mack Mitchell2, Craig McClain3, Srinivasan Dasarathy4, Arthur McCullough5, Svetlana Radaeva4, Aimee Kroll-Desrosiers6, Bruce Barton6, Gyongyi Szabo1b

1a University of Debrecen, Clinical Center, Department of Laboratory Medicine, Debrecen
1b Department of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA;
2 Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX;
3 Department of Medicine, University of Louisville, Louisville, KY;
4 National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD;
5 Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH;
6 Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA

Szekció

Clinical Medicine III. Posters

Language of the presentation

English

Section, first choice

Clinical Medicine

Section, second choice

Theoretical and Translational Medicine

Összefoglaló szövege

Introduction: Acute alcoholic hepatitis (AH) has a high short-term mortality rate. Yet, therapeutic options and clinical scores to manage this disease are limited. The Model for End-Stage Liver Disease (MELD) is generally used to evaluate severity and mortality in different liver diseases. However, new biomarkers may provide more specific tools to assesses AH.
Aims: Our goal was to explore inflammatory landscape of severe AH at the day of hospitalization to build a predictive model for 90-day mortality in a multicentric clinical trial.
Methods: Plasma samples were collected from 85 sever AH patients (MELD≥20) and 27 healthy controls. Patients were randomly assigned to treatment with anakinra (IL-1 receptor antagonist [IL-1Ra]) + pentoxifylline + zinc (n=43) or methylprednisolone (n=42). Plasma samples were analyzed for 43 biomarkers and predictive value of the molecules was assessed for 90-day mortality.
Results: 38 of the 43 biomarkers showed altered levels at baseline compared to healthy controls. 31 patients died during the 90-day follow-up, 18 in the steroid and 13 in the anakinra treatment group. In subgroup analysis of anakinra treated patients, increased IL-6, IL-22 and osteopontin as well as decreased IL-1β, IL-13 and IP-10 levels showed significant association with mortality. In steroid treated patients, high plasma lipocalin-2, MMP-2, low IL-1Ra and MCP-1 levels were found in non-survivors. In the whole cohort including both treatment groups only endotoxin and IL-6 showed significantly increased while IL-13 decreased levels in non-survivors compared to survivors. In Kaplan-Maier analysis, high IL-6 (>25.82 pg/ml) and low IL-13 (≤0.61 pg/ml) levels were significantly associated with mortality. In multivariate Cox regression model including significant clinical factors, high IL-6, low IL-13 and age were independent predictors of mortality. The combination of these 3 factors by binary logistic regression had a superior AUROC compared to MELD. In multivariate Cox regression, MELD lost its significance against the new score. Importantly, our novel score sustained its mortality predicting capacity in each treatment group.
Conclusion: Our data indicate that our new composite score using IL-6, IL-13 and age predicts 90-day mortality regardless of the type of treatment in severe AH with higher performance than the commonly used MELD score.

Additional Information

Péter Antal-Szalmás
antalszp@med.unideb.hu

Bemutatás módja

Szóbeli

Kind

Szabad

Status

elfogadva

Accepted presentation method

poszter

Előadás fájl jóváhagyás

nem rendelkezett róla

Előadó

4761

Start

12:46

End

12:49

Authors (legacy)

David Tornai1a,b, Mack Mitchell2, Craig McClain3, Srinivasan Dasarathy4, Arthur McCullough5, Svetlana Radaeva4, Aimee Kroll-Desrosiers6, Bruce Barton6, Gyongyi Szabo1b

1a University of Debrecen, Clinical Center, Department of Laboratory Medicine, Debrecen
1b Department of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA;
2 Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX;
3 Department of Medicine, University of Louisville, Louisville, KY;
4 National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD;
5 Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH;
6 Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA