Changes in cytokine levels during admission and mortality in acute alcoholic hepatitis.

Cytokine levels are raised in acute alcoholic hepatitis. However, there are disparate results regarding the duration of altered plasma levels, and there are also discrepancies about the relation of changes during the first 15 days after admission with short-term (in-hospital) or long-term mortality. In 56 patients with acute alcoholic hepatitis we found that IL-8, IL-4, Interferon-γ (IFN-γ), malondialdehyde and C-reactive protein remained higher in patients than in 18 age- and sex-matched controls at admission, at the 7th day and at the 15th day after admission. Moreover, IL-4 levels (and to a lesser extent, IL-10 and IFN-γ ones) increased along the three determinations. However, comparing patients who died during the admission with those who did not, there were no statistically significant differences, but there was a nearly significant trend for MDA (Z=1.89; p=0.059), with higher levels among those who died. When changes between the first and the second determinations were compared with long-term survival, only IL-8 and IFN-γ showed a relation with mortality. IFN-γ values increased among those who survived and decreased among those who died (p=0.048). IFN-γ values at the first determination also showed a relation with long-term mortality, especially when patients with IFN-γ values in the first quartile were compared with those of the 4th one (log rank=5.64; p=0.018; Breslow=4.64; p=0.031). Besides Interferon-γ, only C-reactive protein showed differences between the first and the 4th quartile regarding mortality (Log rank=4.50; p=0.034; Breslow 4.33; p=0.038). In contrast with other studies, no relation was found between TNF-α or IL-6 and mortality.

Vitamin D and nutritional status are related to bone fractures in alcoholics.

BACKGROUND: Bone fractures are common in alcoholics. AIMS: To analyse which factors (ethanol consumption; liver function impairment; bone densitometry; hormone changes; nutritional status, and disrupted social links and altered eating habits) are related to bone fractures in 90 alcoholic men admitted to our hospitalization unit because of organic problems. METHODS: Bone homoeostasis-related hormones were measured in patients and age- and sex-matched controls. Whole-body densitometry was performed by a Hologic QDR-2000 (Waltham, MA, USA) densitometer, recording bone mineral density (BMD) and fat and lean mass; nutritional status and liver function were assessed. The presence of prevalent fractures was assessed by anamnesis and chest X-ray film. RESULTS: Forty-nine patients presented at least one fracture. We failed to find differences between patients with and without fractures regarding BMD parameters. Differences regarding fat mass were absent, but lean mass was lower among patients with bone fracture. The presence of fracture was significantly associated with impaired subjective nutritional evaluation (χ² = 5.79, P = 0.016), lower vitamin D levels (Z = 2.98, P = 0.003) and irregular eating habits (χ² = 5.32, P = 0.02). Reduced lean mass and fat mass, and altered eating habits were more prevalent among patients with only rib fractures (n = 36) than in patients with multiple fractures and/or fractures affecting other bones (n = 13). These last were more closely related to decompensated liver disease. Serum vitamin D levels showed a significant relationship with handgrip strength (ρ = 0.26, P = 0.023) and lean mass at different parts of the body, but not with fat mass. By logistic regression analysis, only vitamin D and subjective nutritional evaluation were significantly, independently related with fractures. CONCLUSION: Prevalent fractures are common among heavy alcoholics. Their presence is related more closely to nutritional status, lean mass and vitamin D levels than to BMD. Lean mass is more reduced, nutritional status is more impaired and there is a trend to more altered eating habits among patients with rib fractures, whereas multiple fractures depend more heavily on advanced liver disease.

Prognostic value of nutritional status in alcoholics, assessed by double-energy X-ray absorptiometry.

OBJECTIVES: This study was performed in order to assess nutritional status of 77 alcoholic patients. METHODS: Patients underwent a total body double-energy X-ray absorptiometry (DEXA) analysis, with estimation of lean and fat mass at different parts of the body. RESULTS: Lean mass, but not fat mass, was significantly reduced among alcoholics, compared to 31 age-matched controls, especially at right arm, legs, and total body. Lean mass at both arms was significantly related to liver function parameters (albumin, prothrombin activity, bilirubin) and, inversely, with ethanol consumption. The 24 patients who died during a follow-up period of 88 months showed less lean mass at both arms, trunk, and left leg, and also less fat at the left arm, than survivors. When right and left arm lean mass were classified in quartiles, Kaplan-Meier curves showed significant differences between dead and survivors. Left arm lean mass was the parameter which was independently related to mortality when encephalopathy was not included in a stepwise Cox regression analysis, but was displaced by this last parameter when it was also introduced in the analysis. CONCLUSION: Lean mass is reduced in alcoholics, is related to liver function derangement and ethanol consumption, and is related to mortality.

Relación entre homocisteína y masa ósea en pacientes alcohólicos / Relationship between homocysteine and bone mass in alcoholic patients

Introducción. En el paciente alcohólico se observa la presencia de osteopatía. La homocisteína puede interferir con la formación del colágeno, la mineralización ósea y aumentar el riesgo de fracturas osteoporóticas. Algunos autores han encontrado relación entre la homocisteína y las fracturas óseas pero no se ha estudiado en pacientes alcohólicos. Pacientes y métodos. Estudiar en 43 pacientes alcohólicos la relación entre la densidad mineral ósea, hormonas, osteocalcina, N-Telopéptido terminal y la homocisteína. Grupo control de 63 individuos. Resultados. Los niveles séricos de homocisteína estaban ligeramente más elevados en los pacientes respecto a los controles (más en cirróticos que en no cirróticos) pero no de forma significativa. Un 38,5% de los pacientes presentaba osteoporosis. Aunque en los pacientes con osteoporosis los niveles de homocisteína estaban más aumentados no hallamos relación entre la homocisteína y la densidad mineral ósea en ninguna de las localizaciones analizadas ni en los valores hormonales ni en los marcadores óseos. Conclusiones. No hemos encontrado relación entre el aumento de la homocisteína y la osteoporosis de los pacientes alcohólicos

Introduction. Alcoholism leads to osteoporosis. Homocysteine (tHcys) may weaken bone by interfering with collagen cross-linking. Some authors hve found a relation between tHcys and bone fracture in clinical settings differents from alcoholism. Methods. We studied the relationship between bone mineral density, hormones, bone metabolism markers and homocysteine in 43 alcoholics patients. Data were compared with those obtained on 63 controls. Results. Serum homocysteine were slightly non-significantly higher among patients than controls and among cirrhotic than non-cirrhotic patients. A total of 38.5% patients had osteoporosis. Although homocysteine levels were slightly highly in patients with osteoporosis, no relationships were observed between homocysteine and bone mineral density at any of the bone sites analyzed or in hormones or serum markers of bone metabolism. Conclusion. We found no relationship between the number of homocysteine and osteoporosis of alcoholic patients

Fumador de 49 años con red venosa superficial en tórax y cuello y disfonía / Collateral circulation in thorax and dysphonia in a 49-year old smoker

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Combined effects of steroids, ethanol and protein deficiency on tissue content and urinary and faecal excretion of zinc, copper and iron.

This study was performed in order to determine the relative and combined effects of ethanol, a low protein diet and steroid treatment on bone, muscle, liver, and urinary and faecal excretion of zinc, copper and iron in 64 rats divided into eight groups treated following the Lieber-DeCarli liquid diet technique, with and without dexamethasone, 1 mg/l. Steroids showed a lack of effect on liver zinc, but enhanced ethanol- and low protein-mediated liver iron overload when both factors were combined. Steroids also increased muscle copper, iron and zinc, and bone copper, especially in the low protein, ethanol-fed rats.