Étude de la cinétique de la bilirubine avant traitement par corticostéroïdes dans l'hépatite alcoolique aigüe sévère

Étude de la cinétique de la bilirubine avant traitement par corticostéroïdes dans l'hépatite alcoolique aigüe sévère Introduction: Acute alcoholic hepatitis (AAH) are treated by corticosteroid therapy (CT) when the Maddrey DF is = 32. The decrease in total bilirubin at day 7 is a major prognostic factor and a component of the Lille model predicting survival. The aim of our study was to evaluate the impact on survival of the evolution of biological variables as bilirubin in the week before CT initiation. Patients and methods: 106 patients consecutively hospitalized from January 2007 to December 2010 for a severe acute alcoholic hepatitis and having a DF = 32 were included for a retrospective study. Clinical and laboratory data were collected at admission and during hospitalization. All received CT and were alive 7 days after CT initiation; 28 also received N-acetyl cysteine (NAC). Variables affecting survival were analyzed in a Cox model. Results: Mean age was 53 (24-74), 61% were male and 85% had cirrhosis. All patients had an active consumption of alcohol. The mean time between admission and initiation of CT was 10 days (4-31). The 3 and 6-months survivals were 69 % and 60 %. In multivariate analysis, younger patients (p=0.04), decrease in bilirubin level at 7 days CT (p <0.0002), and decrease of bilirubin before steroid (DBBS) (p< 0. 0003) had better3-months survival. DBBS was observed in 55% of patients and 88% with DBBS were still alive at 3 months vs 40% without DBBS. This later variable was related to response to CT and adding the DBBS variable to Lille Model or DF increased the AUROC. Conclusion: The present study indicates that in patients with severe acute alcoholic hepatitis, DBBS is a significantly independent predictor for both the response to CT and the 3 months survival. This could help to rapidly define the patients with a poor prognostic for whom other therapies than CT could be attempted such as transplantation or bio-artificial livers.NANTES-BU Médecine pharmacie (441092101) / SudocSudocFranceF

Acute Ulceronecrotic Gastritis With Cytomegalovirus Reactivation: Uncommon Toxicity of Immune Checkpoint Inhibitors in Microsatellite Instability–High Metastatic Colorectal Cancer

International audienceNo abstract availabl

Nivolumab‐induced celiac‐like enteropathy in patient with metastatic renal cell carcinoma: Case report and review of the literature

International audienceNivolumab may induce severe celiac-like enteropathy, that may appear very rapidly, after only two injections of nivolumab, and may be successfully treated with corticosteroids. This observation underlines the importance of histological analysis of duodenal biopsies and the necessity to rule out a real celiac disease in patients with nivolumab-induced diarrhea