Evidence map›Paper›PMID 32072435›Full record

ArticleDigestive diseases and sciences2020

A Combination of N-Acetylcysteine and Prednisone Has No Benefit Over Prednisone Alone in Severe Alcoholic Hepatitis: A Retrospective Analysis.

Waseem Amjad, Joseph Alukal, Iliana Doycheva, Talan Zhang, Anurag Maheshwari, Hwan Yoo, Paul J Thuluvath

Abstract read
PubMed Publisher
In one paragraph

Article in Digestive diseases and sciences, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 1 pooled it
1.7field-weighted citation impact, top 16% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 1 synthesis or guideline pooled it, 16 citations in OpenAlex.

  1. Pooled it
  2. Review
  3. Review
  4. Review
  5. Review
  6. Review
  7. Article
  8. Emerging Pharmacotherapies in Alcohol-Associated Hepatitis.Journal of clinical and experimental hepatology
    Review
  9. Current Medical Treatment for Alcohol-Associated Liver Disease.Journal of clinical and experimental hepatology
    Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors at 1 institution in 1 country.

Waseem AmjadInstitute of Digestive Heath and Liver Diseases, Mercy Medical Center, Baltimore, MD, 21202, USA.
Joseph AlukalInstitute of Digestive Heath and Liver Diseases, Mercy Medical Center, Baltimore, MD, 21202, USA.
Iliana DoychevaInstitute of Digestive Heath and Liver Diseases, Mercy Medical Center, Baltimore, MD, 21202, USA.
Talan ZhangInstitute of Digestive Heath and Liver Diseases, Mercy Medical Center, Baltimore, MD, 21202, USA.
Anurag MaheshwariInstitute of Digestive Heath and Liver Diseases, Mercy Medical Center, Baltimore, MD, 21202, USA.
Hwan YooInstitute of Digestive Heath and Liver Diseases, Mercy Medical Center, Baltimore, MD, 21202, USA.
Paul J ThuluvathInstitute of Digestive Heath and Liver Diseases, Mercy Medical Center, Baltimore, MD, 21202, USA. thuluvath@gmail.com.
Mercy Medical Center · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionIn this study, we assessed whether there were any survival advantages with a combination treatment of intravenous N-acetylcysteine (NAC) and prednisone over prednisone alone in those with severe alcoholic hepatitis [discriminant function (DF) ≥ 32]. PATIENTS AND

methodsBetween January 1, 2013, and February 28, 2019, we identified 68 patients (mean age 47.2 years ± 10.1, 57% women, 65% cirrhosis, MELD score 28.1 ± 6.6) with alcoholic hepatitis, and of those, 21 (31%) received prednisone and 47 (69%) received prednisone + NAC. Lille score ≥ 0.45 was considered a poor response. Renal insufficiency was defined as GFR < 60 ml/min/1.73m

resultsDF (74.2 ± 33.6 vs. 56.9 ± 15.9, p = 0.09) was similar, but MELD (29.2 ± 6.3 vs. 25.5 ± 6.4, p = 0.03) scores were higher in the combination group. The overall 30-day and 90-day mortality was 13.2% (9/68) and 20.6% (14/68), respectively. Women were more likely (OR 4.86, 95% CI 1.62-14.59) to respond to treatment based on Lille score compared to men, but the type of treatment regimen had no effect on Lille score (OR 0.84, 95% CI 0.25-2.78). Treatment regimen had no effect on both adjusted and unadjusted survivals. Multivariate analysis, after adjusting for confounding variables, confirmed these observations. DF + renal insufficiency had the highest AUROC (0.86) to predict mortality.

conclusionThe combination treatment of NAC + prednisone is not better than prednisone alone in patients with severe alcoholic hepatitis.

Indexed as

AcetylcysteineHepatitis, AlcoholicLiver CirrhosisPrednisoneAdultAnti-Inflammatory AgentsDrug MonitoringDrug Therapy, CombinationFemaleFree Radical ScavengersHumansMaleOutcome and Process Assessment, Health CareRenal InsufficiencySurvival AnalysisUnited StatesAcetylcysteineAnti-Inflammatory AgentsFree Radical ScavengersPrednisoneAlcoholic hepatitisChild–Pugh scoreCombination treatment with NAC and prednisoneDiscriminant functionGlasgow alcoholic hepatitis scoreLille scoreModel for end-stage liver diseasesN-acetylcysteinePrednisoneRenal insufficiency

Identifiers

PMID32072435
OpenAlexW3008850470

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.