Complex Exploratory Study of Alcohol-Associated Hepatitis

Alcohol-associated hepatitis is a clinical syndrome distinct from steatohepatitis or liver cirrhosis. It is associated with high mortality and characterized by an absence of effective treatment, while corticosteroids, which are currently used as the first-line treatment are effective only in a subpopulation of patients and only on 28-days survival - their effect on survival does not last beyond this interval. The proposed study is a complex exploratory study of alcohol-associated hepatitis with the following aims: (1) to estimate the standardized annual incidence of (severe) AH in the Kosice Urban Area, (2) to estimate the threshold of alcohol consumption associated with (an increased risk of) developing AH, (3) to compare the diagnostic accuracy of NIAAA vs NIAAAm-CRP against liver biopsy, (4) to perform a head-to-head comparison of widely-accepted prognostic models and to develop prognostic models, (5) to observe prognosis of nonsevere alcohol-associated hepatitis, (6) to observe the evolution of severe alcohol-associated hepatitis, (7) to describe the association of hypothalamus-hypopituitary-adrenal axis and Gut-Liver Microbiome Axis and Prognosis of Alcohol-associated Hepatitis, (8) to describe the adherence to outpatient psychiatric management and its impact on long-term prognosis, (9) to perform a longitudinal evaluation of nutritional status, its changes, and its impact on long-term prognosis.

Study Design This is a multicenter observational study of patients with alcohol-associated hepatitis. The total trial duration for each subject is approximately 53 weeks. This includes a screening period of a maximum of one week (7 days), during which the diagnosis of AH will be confirmed, followed by a 52 weeks (365 days) observational period.

Diagnosis of Alcohol-associated Hepatitis The diagnosis of alcohol-associated hepatitis will be established using the National Institute on Alcohol Abuse and Alcoholism (NIAAA) diagnostic criteria: onset of jaundice within prior 8 weeks; ongoing consumption of >40 (females) or >60 (males) g alcohol/day ≥ 6 months, with less than 60 days of abstinence before the onset of jaundice; aspartate aminotransferase >0.83µkat/L (but less than 6.64 µkat/L), AST/ALT > 1.5, and total serum bilirubin > 51.3 mmol/L.

NIAAA definitions for AH differentiate between possible AH (clinically diagnosed with potential confounding factors), in which transjugular liver biopsy is indicated, probable AH (clinically diagnosed without potential confounding factors), and definite AH (clinically diagnosed and biopsy proven).

Considerations Regarding Patient Admission and Discharge Local standards dictate that patients with acute liver injury or acute liver failure are typically admitted to the 2nd Department of Internal Medicine, which specializes in gastroenterology and hepatology. This admission is carried out to facilitate further differentiation and provide specific treatment tailored to their condition. However, patients have the option to decline admission and, in such cases, will be discharged and managed as outpatients.