Acute Alcoholic Hepatitis: Natural History and Predictors of Mortality Using a Multicenter Prospective Study

Objective: To examine the natural history of acute alcoholic hepatitis (AH) and identify predictors of mortality for AH using data from a prospective multicenter observational study. Participants and Methods: We analyzed data from 164 patients with AH and 131 heavy-drinking controls with no liver disease. Participants underwent clinical/laboratory assessment at baseline and 6 and 12 months after enrollment. Multivariable analyses were conducted to identify variables associated with mortality and examine the association between coffee drinking and risk of AH. Results: Thirty-six patients with AH died during follow-up, with estimated 30-day, 90-day, 180-day, and 1-year survival of 0.91 (95% CI, 0.87-0.96), 0.85 (95% CI, 0.80-0.91), 0.80 (95% CI, 0.74-0.87), and 0.75 (95% CI, 0.68-0.83), respectively. In the multivariable analysis, higher serum bilirubin level (hazard ratio [HR]=1.059; 95% CI, 1.022-1.089), lower hemoglobin level (HR=1.263; 95% CI, 1.012-1.575), and lower platelet count (HR=1.006; 95% CI, 1.001-1.012) were independently associated with mortality in AH. Compared with controls, fewer patients with AH regularly consumed coffee (20% vs 44%; P<.001), and this association between regular coffee drinking and lower risk of AH persisted after controlling for relevant covariates (odds ratio=0.26; 95% CI, 0.15-0.46). Time-dependent receiver operating characteristic curve analysis revealed that Model for End-Stage Liver Disease; Maddrey Discriminant Function; age, serum bilirubin, international normalized ratio, and serum creatinine; and Child-Pugh scores all provided similar discrimination performance at 30 days (area under the curve=0.73-0.77). Conclusion: Alcoholic hepatitis remains highly fatal, with 1-year mortality of 25%. Regular coffee consumption was associated with lower risk of AH in heavy drinkers

Desain Dermaga Apung dan Penangkap Sampah di Kawasan Ekowisata Mangrove Wonorejo, Surabaya

Kawasan hutan mangrove merupakan kawasan yang memiliki banyak manfaat untuk menjaga kelestarian pantai. Misalnya saja : melindungi pantai dari abrasi dan erosi, menjadi tempat hidup dan berkembang biak biota laut (ikan, kepiting, udang, burung, dsb), dan juga memiliki potensi sebagai tempat edukasi dan pariwisata. Ekowisata Mangrove Wonorejo di pantai Timur Surabaya merupakan salah satu tempat pelestarian hutan mangrove di Surabaya. Ekowisata Mangrove Wonorejo menyediakan beberapa fasilitas umum seperti kolam pancing, tempat kuliner, dan kapal wisata. Namun, masyarakat di daerah sekitar Ekowisata Mangrove Wonorejo kurang memperhatikan kebersihan sungai. Hal ini dapat terlihat dari banyaknya sampah yang terdapat di sekitar aliran sungai yang pada akhirnya merusak kelangsungan hidup hutan mangrove, sehingga kelangsungan biota laut tidak dapat berjalan dengan baik. Penangkap sampah di sungai dapat menjadi salah satu alternatif untuk mengatasi masalah tersebut. Penangkap sampah ini dirancang menyatu dengan dermaga yang akan diperbaharui, dan akan didesain dengan konsep dermaga apung sehingga baik untuk kelangsungan hidup hutan mangrove. Diharapkan dengan adanya penangkap sampah dapat meminimalisasi sampah yang terdapat di sekitar aliran sungai, sehingga kelangsungan hidup tanaman mangrove dapat menjadi lebih baik. Selain itu, konsep pondasi apung dapat menciptakan dermaga yang ramah lingkungan serta mudah dalam proses pembuatannya. Kata kunci: Pantai Timur Surabaya, Ekowisata Mangrove Wonorejo, dermaga apung, penangkap sampa

Acute Alcoholic Hepatitis

Objective: To examine the natural history of acute alcoholic hepatitis (AH) and identify predictors of mortality for AH using data from a prospective multicenter observational study. Participants and Methods: We analyzed data from 164 patients with AH and 131 heavy-drinking controls with no liver disease. Participants underwent clinical/laboratory assessment at baseline and 6 and 12 months after enrollment. Multivariable analyses were conducted to identify variables associated with mortality and examine the association between coffee drinking and risk of AH. Results: Thirty-six patients with AH died during follow-up, with estimated 30-day, 90-day, 180-day, and 1-year survival of 0.91 (95% CI, 0.87-0.96), 0.85 (95% CI, 0.80-0.91), 0.80 (95% CI, 0.74-0.87), and 0.75 (95% CI, 0.68-0.83), respectively. In the multivariable analysis, higher serum bilirubin level (hazard ratio [HR]=1.059; 95% CI, 1.022-1.089), lower hemoglobin level (HR=1.263; 95% CI, 1.012-1.575), and lower platelet count (HR=1.006; 95% CI, 1.001-1.012) were independently associated with mortality in AH. Compared with controls, fewer patients with AH regularly consumed coffee (20% vs 44%; P<.001), and this association between regular coffee drinking and lower risk of AH persisted after controlling for relevant covariates (odds ratio=0.26; 95% CI, 0.15-0.46). Time-dependent receiver operating characteristic curve analysis revealed that Model for End-Stage Liver Disease; Maddrey Discriminant Function; age, serum bilirubin, international normalized ratio, and serum creatinine; and Child-Pugh scores all provided similar discrimination performance at 30 days (area under the curve=0.73-0.77). Conclusion: Alcoholic hepatitis remains highly fatal, with 1-year mortality of 25%. Regular coffee consumption was associated with lower risk of AH in heavy drinkers