S2633 Neutrophil Count as a Prognostic Marker in Alcoholic Hepatitis: A Nationwide Analysis

Introduction: Alcoholic liver disease is the leading cause of liver-related mortality. Recent molecular studies have suggested that polymorphonuclear (PMN) counts might affect both steroid responsiveness and prognosis of patients with alcoholic hepatitis (AH). However, there is currently a lack of clinical studies confirming these findings. Therefore, we explored real-world data to assess the impact of neutrophil counts on the outcomes of patients hospitalized with AH. Methods: This retrospective cohort study used the TriNetX research network to identify patients hospitalized with AH and treated with glucocorticoid therapy, stratified by neutrophil levels (e.g., normal polymorphonuclears (PMN) between 1500-8000/μL; neutropenia or PMN <1500/μL; neutrophilia or PMN >8000/μL). Patients were propensity-matched for demographics, body mass index (BMI), comorbid conditions, and AH treatment (e.g., glucocorticoids, pentoxyfilline). Outcomes included the 6-month all-cause mortality and liver transplantation (LT) rates among adult patients with AH, and liver chemistries at 1-month, 3-month, and 6-month follow-up. Results: 8843 patients hospitalized with AH and neutrophilia were propensity-matched with 8843 patients with normal PMN counts. Patients with AH and neutrophilia had respective 5- and 4-fold increases in all-cause mortality compared to those with normal PMN levels (adjusted Odds Ratio (aOR) = 5.35, 95% CI: 4.91–5.83) and those with neutropenia (aOR = 4.13, 95% CI: 3.4–5.02), while those with neutropenia had a 30% increase in all-cause mortality as compared to those with normal PMN levels (1.3, 95% CI: 1.03–1.65). Furthermore, LT rates were lower in patients with neutrophilia (aOR = 0.27, 95% CI: 0.19–0.37) and neutropenia (aOR = 0.37, 95% CI: 0.18–0.78) compared to those with normal PMN levels. Patients with neutrophilia had significantly higher mean aspartate aminotransferase (P < 0.001), alanine aminotransferase (P < 0.01), total bilirubin (P < 0.001), INR (P < 0.001), and creatinine (P < 0.001) within 6-month follow-up as compared to those with normal PMN levels. Conclusion: This cohort study provides real-world data showing significantly increased odds for all-cause mortality and higher degree of liver injury in patients with AH and elevated neutrophil counts as compared to patients with low-to-normal neutrophil counts. Therefore, additional prospective studies should further clarify the association of neutrophilia and poor outcomes in patients with alcoholic hepatitis.