Prevalence of septic events, type 1 hepatorenal syndrome, and mortality in severe alcoholic hepatitis and utility of discriminant function and MELD score in predicting these adverse events

Abstract

We sought to assess prevalence, and utility of discriminant function (DF) and MELD score in predicting septic events (SE), type 1 hepatorenal syndrome (HRS), and short-term mortality in severe alcoholic hepatitis (AH). Charts of patients with AH (group 1) and cirrhosis without AH (group 2) were retrospectively reviewed. Severe AH, discriminant function (DF) >or= 32 was treated with pentoxifylline. One hundred ninety-five patients were enrolled in the study and divided into 2 groups: group 1, n=99, and group 2, n=96. Of those with AH, 82% had a DF >or= 32 at presentation. Group 1 patients had a higher prevalence of SE (38% versus 25%, P=.04), type 1 HRS (30% versus 9%, P=.0003), and short-term mortality (28% versus 7%, P=.0001). In patients with AH, a MELD score >or=20 (but not a DF >or= 32) at presentation was an independent predictor of a SE (odds ratio [OR] 2.8 [1.0-7.9], P=.04), HRS (OR 4.0, 95% confidence interval [CI] 1.0-16.6, P=0.05), and short-term mortality (OR 6.4, 95% CI 1.1-37.6, P=.03). Kaplan-Meier survival curves confirmed that that a MELD >or= 20 but not a DF >or= 32 was associated with a poorer survival (P = .005 and .5, respectively). In conclusion, patients with severe AH have higher prevalence of SE, HRS, and short-term mortality compared to those with cirrhosis without AH. A MELD score >or=20 at presentation is an independent predictor of these adverse events in patients with AH who have been treated with pentoxifylline.