P3719 - Neutrophil Count as a Prognostic Marker in Alcoholic Hepatitis: A Nationwide Analysis

Yassine Kilani, MD¹, Mahmoud Y. Madi, MD², Daniel Alejandro Gonzalez Mosquera, MD³, Shahryar Khan, MD⁴, Saqr Alsakarneh, MD, MS⁵, Mohammad Aldiabat, MD⁶, Kamran Qureshi, MD¹
1Saint Louis University School of Medicine, Saint Louis, MO; 2University of Texas at Austin Dell Medical School, Austin, TX; 3NYC Health + Hospitals/Lincoln, New York, NY; 4University of Kansas Medical Center, Kansas City, KS; 5Mayo Clinic, Kansas City, MO; 6Washington University School of Medicine in St. Louis, Saint Louis, MO

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; Table 1). 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 (Table 1). Patients with neutrophilia had significantly higher mean AST (p< 0.001), ALT (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 (Table 2).

Discussion: 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.


Figure: Table 1. Six-month outcomes of alcoholic hepatitis (AH) hospitalizations stratified by neutrophil levels: comparison of neutrophilia vs. normal polymorphonuclear (PMN) counts (A), neutropenia vs. with normal PMN counts (B), and neutrophilia vs. neutropenia (C). Records with pre-inclusion outcomes were excluded from the analysis


Figure: Table 2. Trends of liver function tests of Alcoholic hepatitis related hospitalizations stratified by neutrophil levels

Disclosures:
Yassine Kilani indicated no relevant financial relationships.
Mahmoud Madi indicated no relevant financial relationships.
Daniel Alejandro Gonzalez Mosquera indicated no relevant financial relationships.
Shahryar Khan indicated no relevant financial relationships.
Saqr Alsakarneh indicated no relevant financial relationships.
Mohammad Aldiabat indicated no relevant financial relationships.
Kamran Qureshi: Gilead Sciences – Speakers Bureau. Intercept Pharmaceuticals – Speakers Bureau. Madrigal Pharmaceuticals – Speakers Bureau. Phathom Pharmaceuticals – Speakers Bureau. Salix Pharmaceuticals – Speakers Bureau.

Yassine Kilani, MD¹, Mahmoud Y. Madi, MD², Daniel Alejandro Gonzalez Mosquera, MD³, Shahryar Khan, MD⁴, Saqr Alsakarneh, MD, MS⁵, Mohammad Aldiabat, MD⁶, Kamran Qureshi, MD¹. P3719 - Neutrophil Count as a Prognostic Marker in Alcoholic Hepatitis: A Nationwide Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.