Severe alcoholic hepatitis as precipitant for organ failure and ACLF

Abstract

Alcoholic hepatitis is the acute deterioration of alcoholic liver disease with rapid onset or worsening of jaundice, which in severe cases, may transition to acute-on-chronic liver failure with extremely high short-term mortality, increasing with the number and severity of hepatic and extra-hepatic organ dysfunction. Diagnosis and treatment are insufficient and challenging, especially due to the complex, multi-factorial and as yet not fully understood pathogenesis. While current management is limited to steroids and best supportive care, debate is ongoing concerning liver transplantation for selected patients, and several novel approaches are under way with mixed results. These drawbacks in disease management together with increasing prevalence in Germany, and generally in Western countries, constitute an unmet need for the healthcare systems. This review tries to summarize the current status of these aspects and provides an overview for pathogenesis, management and potential future treatments.

Zusammenfassung

Alkoholhepatitis ist die akute Verschlechterung der alkoholischen Lebererkrankungen mit einem raschen Auftreten oder einer Verschlechterung des Ikterus und in schweren Fällen mit der Transition zum akut-auf-chronischem Leberversagen mit einer horrenden Kurzzeitmortalität, die mit der Anzahl und Schwere der hepatischen und extrahepatischen Organdysfunktion ansteigt. Die Diagnose und Behandlung sind unbefriedigend und herausfordernd, vor allem wegen der komplexen und multifaktoriellen, unzureichend verstandenen Pathogenese. Während das aktuelle Management auf Steroide und “best supportive care” beschränkt ist, wird heftig über die Lebertransplantation für ausgewählte Patienten diskutiert, und mehrere neuere Strategien werden derzeit getestet mit gemischten Ergebnissen. Durch diese Nachteile des Managements zusammen mit der wachsenden Prävalenz in Deutschland und allgemein in westlichen Ländern, bezeichnet man die Alkoholhepatitis als ein „unmet need“ für das Gesundheitssystem. Diese Übersichtsarbeit versucht den aktuellen Stand dieser Aspekte zusammenzufassen und einen Überblick über die Pathogenese, Management und potenzielle zukünftige Therapien widerzugeben.

Schlüsselwörter

ASH - ACLF - systemische Entzündung - Lebertransplantation

Keywords

ASH - ACLF - systemic inflammation - liver transplantation

Publication History

Received: 28 September 2021

Accepted after revision: 02 December 2021

Article published online:
18 January 2022

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