Sistema de Salut de Catalunya
Institut Català de la Salut
[Idalsoaga F] Departamento de Gastroenterología, Pontificia Universidad Católica de Chile, Santiago, Chile. Division of Gastroenterology and Hepatology, Western University and London Health Sciences Centre, London, Ontario, Canada. [Diaz LA] Departamento de Gastroenterología, Pontificia Universidad Católica de Chile, Santiago, Chile. MASLD Research Center, Division of Gastroenterology and Hepatology, University of California San Diego, San Diego, California, USA. [Dunn W, Mehta H] Division of Gastroenterology, Department of Medicine, University of Kansas Medical Center, Kansas City, Missouri, USA. [Caldentey V] Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. [Arnold J] Departamento de Gastroenterología, Pontificia Universidad Católica de Chile, Santiago, Chile. [Ventura Cots M] Universitat Autònoma de Barcelona, Bellaterra, Spain. Servei d’Hepatologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain
Vall d'Hebron Barcelona Hospital Campus
2025-06-05T10:00:40Z
2025-06-05T10:00:40Z
2025-04
Acute kidney injury; Liver diseases, alcoholic; Pentoxifylline
Lesión renal aguda; Enfermedades hepáticas alcohólicas; Pentoxifilina
Lesió renal aguda; Malalties hepàtiques alcohòliques; Pentoxifil·lina
Background Severe alcohol-associated hepatitis (sAH) is a life-threatening condition with high mortality, where corticosteroid use is the only treatment that has shown short-term benefits. Pentoxifylline, an anti-tumour necrosis factor-alpha agent, has been proposed for its potential to improve outcomes, especially in patients with acute kidney injury (AKI). We aimed to evaluate the impact of pentoxifylline on mortality in patients with sAH and AKI in a well-characterised global cohort. Methods We conducted a retrospective, registry-based study including patients meeting the National Institute on Alcohol Abuse and Alcoholism clinical criteria for sAH and AKI. Mortality was the primary endpoint, with liver transplantation as a competing risk. Statistical analysis included Cox regression and Kaplan-Meier survival estimates. Results We included 525 patients from 20 centres across eight countries. The median age was 48 years, with 26.1% females, and 76.9% had a history of cirrhosis. Multivariable Cox regression models showed that pentoxifylline use was not associated with survival (HR 1.20, 95% CI 0.85 to 1.69, p=0.291). Factors associated with mortality included age (HR 1.23, 95% CI 1.10 to 1.36, p<0.001), Model for End-Stage Liver Disease score at admission (HR 1.06, 95% CI 1.04 to 1.08, p<0.001) and renal replacement therapy use (HR 1.39, 95% CI 1.05 to 1.84, p=0.019). The main causes of death were multiple organ failure (42%), infections (10%), oesophageal varices bleeding (7%) and renal failure (6%). Conclusion Pentoxifylline showed no significant benefit on mortality in patients with sAH and AKI. Further studies are needed to refine treatment strategies for this high-risk group.
MA receives support from the Chilean government through the Fondo Nacional de Desarrollo Científico y Tecnológico (FONDECYT 1241450).
Article
Published version
English
Hepatitis - Tractament; Hepatitis - Mortalitat; Alcoholisme; Fosfodiesterases - Inhibidors - Ús terapèutic - Efectes secundaris; Insuficiència renal aguda - Tractament; Avaluació de resultats (Assistència sanitària); DISEASES::Digestive System Diseases::Liver Diseases::Hepatitis::Hepatitis, Alcoholic; Other subheadings::Other subheadings::Other subheadings::/drug therapy; CHEMICALS AND DRUGS::Chemical Actions and Uses::Pharmacologic Actions::Molecular Mechanisms of Pharmacological Action::Enzyme Inhibitors::Phosphodiesterase Inhibitors; Other subheadings::Other subheadings::Other subheadings::/adverse effects; DISEASES::Male Urogenital Diseases::Urologic Diseases::Kidney Diseases::Renal Insufficiency::Acute Kidney Injury; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Prognosis::Treatment Outcome::Treatment Failure; ENFERMEDADES::enfermedades del sistema digestivo::enfermedades hepáticas::hepatitis::hepatitis alcohólica; Otros calificadores::Otros calificadores::Otros calificadores::/farmacoterapia; COMPUESTOS QUÍMICOS Y DROGAS::acciones y usos químicos::acciones farmacológicas::mecanismos moleculares de acción farmacológica::inhibidores enzimáticos::inhibidores de fosfodiesterasas; Otros calificadores::Otros calificadores::Otros calificadores::/efectos adversos; ENFERMEDADES::enfermedades urogenitales masculinas::enfermedades urológicas::enfermedades renales::insuficiencia renal::lesión renal aguda; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::pronóstico::resultado del tratamiento::fracaso del tratamiento
BMJ
eGastroenterology;3(2)
https://doi.org/10.1136/egastro-2024-100179
Attribution-NonCommercial 4.0 International
http://creativecommons.org/licenses/by-nc/4.0/
Articles científics - HVH [3440]
