Dr Ashwin Dhanda (Liver)

Ashwin Dhanda – 2017 Trainee Research Award

Institution: Plymouth University Peninsula School of Medicine

Title: Can assessment of global immune function predict outcome and response to corticosteroid treatment in patients with severe alcoholic hepatitis?

Project Start Date: 16th October 2017

Completion Date: 15th October 2018

Summary: Alcoholic hepatitis is a serious condition caused by long-term heavy alcohol consumption. It accounts for around 2% of all hospital admissions. If severe, it leads to liver failure and death in nearly 1 in 3. Only steroid treatment improves survival but around 1 in 3 do not respond and have a very high chance of dying from their condition. It is therefore important to be able to predict an individual patient’s response to steroids. This will improve personalised patient care and the chance of survival from this condition. We have previously shown that a blood test accurately measures response to steroids in most patients. However, it is difficult to perform and could not be used in the NHS. To develop a simpler test, we have looked at markers of inflammation produced by certain types of white blood cells and have shown a difference that could be exploited in a new test, which is already commercially available. In the proposed study, we will investigate whether this new test can be used to predict survival of patients with alcoholic hepatitis. If so, it could easily be incorporated into NHS practice to improve the care we can provide to this sick patient group.

I will recruit patients from the South West Liver Unit at Plymouth Hospitals NHS Trust and perform laboratory work in Plymouth University Peninsula School of Medicine. I will be supported by the Hepatology Research Group and guided by my mentor, Professor Matthew Cramp.

During this project, we will take blood samples from 24 patients with severe alcoholic hepatitis and use a newly developed blood test to measure markers of inflammation. We will follow up these patients for 3 months to find out whether any measurement predicts their survival at that time. This study will commence in October 2017 with patient recruitment completed within 9 months. The study will be completed 3 months after the final patient is recruited. We will then analyse results and produce a report including a lay summary by the end of 2018.

If this project is successful, it will identify potential new blood markers of survival. These “biomarkers” will be evaluated in a large multicentre study. The blood test can then be incorporated into clinical practice to help identify patients at higher risk of dying from their condition. These patients can then be offered alternative therapy or entered into clinical trials of new treatments at an early stage.

I have been working with patients with severe alcoholic hepatitis for a number of years and have recognised that despite improvements in overall care, long-term survival remains poor. We have already started to investigate changes in their immune system and I am keen to learn more about this. In doing so I hope to develop a new tool that has the potential to improve the survival of this patient group.

Completion of this project will build on my clinical and research expertise in the field of alcohol related liver disease. It will place me in a better position to work collaboratively at a national level to develop clinical studies to improve patient outcome from alcoholic hepatitis and other causes of chronic liver disease.

I would like to thank Guts UK for its generous support of this project. I hope that this project will ultimately improve survival of patients with alcoholic hepatitis, a serious condition leading to liver failure and death in up to 1 in 3. By using a simple blood test to measure immune function we will look for a marker that can predict survival of these patients. If successful, this blood test can be incorporated into everyday clinical practice to guide treatment options.

Dr Ashwin Dhanda