The Effect Of Gutuojiejiu Decoction On Survival In Patients With Severe Alcoholic Hepatitis:A Retrospective Cohort Study

Back ground In patients with alcoholic hepatitis,the progression of hepatic failure,such as blood coagulation disturbance,jaundice,hepatic encephalopathy,acute renal failure,upper gastrointestinal bleeding always suggests the development of severe alcoholic hepatitis(SAH),which is frequently complicated by endotoxemia.Additionally,the6-month mortality is as high as 40%.Glucocorticoid has become a first-line therapy for SAH.But this treatment is not free of adverse effects and has been considered controversial.Thus,finding new effective and safe therapeutic options is frequently necessary.Numerous studies have reported that patients treated by Integrated Medicine for alcoholic hepatitis could benefit more.For there are some limitations of randomized controlled trials in clinical researches of Traditional Chinese Medicine,a retrospective cohort study can be carried out.Aim To verify the value of Gutujiejiu decoction on survival of patients with SAH.Methods This was a single center retrospective cohort study performed in consecutive patients diagnosed with SAH at Teaching Hospital of Chengdu University of Traditional Chinese Medicine.Traditional Chinese Medicine(TCM)formula Gutuojiejiu decoction was employed as an exposure factor.Patients were assigned to observation group or control group based on whether they had been treated by Gutuojiejiu decoction.A retrospective analysis was run by comparing age,alcohol intake,leukocyte(WBC),neutrophil(N),hemoglobin(HGB),platelet(PLT),blood urea nitrogen(BUN),sodium,total bilirubin(TBIL),alanine aminotransferase(ALT),aspartate aminotransferase(AST),Gamma glutamyltranspeptidase(GGT),Prothrombin time(PT),International normalized ratio(INR),Child-Turcotte-Pugh(CTP),Maddrey’s discriminant function(MDF)score and Model for end-stage liver disease(MELD)score,score of TCM symptom before and after treatment for 12-and52-week.Additionally,the 90-and 365-day cumulative survival rates,the occurrence of complications and side-effects were analyzed as well.Results1.A total of 179 cases were collected.All the patients were males.131 patients were eligible for our study.68 of them were in the observation group and the other 63 were in the control group.2.The 90 and 365 day cumulative proportion surviving of observation group and control group were respectively as follows [56/68(82.4%)vs 28/63(44.4%)] and[48/68(70.6%)vs 14/63(22.2%)].the differences of survival rates between the two groups were statically significant(P=0.0000).3.After the first 12 weeks of treatment,improvements of clinical parameters,scoring systems related to liver injury and score of TCM symptom in the observation group were better than that of the control group(most P<0.05),after treatment for 52 weeks,the difference was more significant(all P<0.05).4.In comparing with complications and adverse effects,there was no significant difference between the two groups.Conclusion This study suggested that Gutuojijiu decoction could improve survival rates and clinical parameters of liver injury in patients with SAH,but it could not reduce the side-effects of prednisone and the occurrence of complications.