Lung infection ups risk of death in patients with severe alcohol-related hepatitis

Patients with severe alcohol-related hepatitis (AH) are likely to develop lung infection, which influences mortality at admission and after steroid initiation, a study has shown.

A team of investigators examined all patients admitted for severe AH between 2020 and 2022. They carried out a systematic screening for infection at admission, which was then renewed in the case of clinical suspicion.

Of the 614 patients (mean age 49.9 years, 60.4 percent men, median model for end-stage liver disease [MELD] 25.2, bilirubin 18.1 mg/dL), 202 (32.9 percent) had infections at admission (73 lung infections).

Multivariate analysis revealed the following factors associated with lung infection at admission: MELD score (p=0.0002), encephalopathy (p=0.006), and tobacco exposure (past vs never smokers: p=0.002; active vs past smokers: p=0.005).

In addition, MELD score (p=0.05), encephalopathy (p=0.003), and especially lung infection (p<0.0001) independently correlated with death before steroid initiation. Patients with a lung infection, therefore, had a lower probability of receiving steroids than those with other infections and with noninfected patients (54.8 percent vs 88.4 percent vs 98.1 percent; p<0.0001).

Some 146 patients who received corticosteroids developed an infection, including pneumonia in 57 (39.04 percent). Nonresponders to steroids (Lille score ≥0.45) had a higher risk of respiratory and nonrespiratory infections than responders (13 percent vs 7.6 percent; p=0.03 and 27.9 percent vs 10.6 percent; p<0.001, respectively).

Furthermore, the following factors independently correlated with 3-month mortality after steroid initiation: lung infection (p=0.004), nonresponse to steroids (p<0.0001), MELD score (p=0.0003), ascites (p=0.003), and encephalopathy (p=0.018). Of note, nonrespiratory infection was not associated with death (p=0.91).

“These results emphasize the need for specific management of lung infection during the course of AH,” the investigators said.