Predictors and prognosticators of outcomes in alcoholic hepatitis: A retrospective single center study

Abstract

Background: Various prognostic scores have been developed to predict mortality and response to steroids in alcoholic hepatitis (AH). We aimed to further validate and compare these scores, particularly pre-day 7 Lille scores, in addition to identifying reliable predictors of complications and mortality such as renal dysfunction and nutritional status.

Aim: To identify predictors of complications and mortality in AH, particularly focusing on demographics, renal involvement, underlying liver disease, and nutrition.

Methods: This is a retrospective analysis of patients admitted to a large urban tertiary care center with AH from 2020 to 2022. Receiver operating characteristics (ROC) curve analysis was conducted to compare established prognostic scores with Lille scores from day 3 to day 7 (LM3-7). Logistic regression equations were conducted to identify predictor variables.

Results: Severe AH (SAH) as defined by Maddrey's discriminant function ≥ 32 was diagnosed in 150 out of 425 patients with AH. LM3-7 had 28-day mortality rates in the responder group of 7%-11%, while in the non-responder group, mortality rates were approximately 38%-42%. LM3-7 had 90-day mortality rates in the responder group of 12% to 17%, while in the non-responder group, mortality rates were 48%-53%. Furthermore, all LM3-7 scores showed comparable efficacy in predicting mortality using ROC curve analysis; Area under ROC ranged from 0.771 to 0.802 for 28-day mortality and 0.743 to 0.809 for 90-day mortality. Regarding complications and mortality in AH, significant predictors included poor nutritional status, underlying cirrhosis, and acute renal dysfunction.

Conclusion: LM3-6 is as accurate as LM7 in predicting corticosteroid efficacy for 28-day and 90-day mortality in patients with SAH. Holding glucocorticoids early during the disease course can prevent unnecessary complications.

Keywords: Acute liver failure; Alcoholic hepatitis; Alcoholic liver disease; Lille score; Nutrition.

Figure 1

Receiver operating characteristic curves for predictive scores. A: Twenty-eight days mortality; B: Ninety days mortality. ABIC: Age-bilirubin-INR-creatinine; GAHS: Glasgow alcoholic hepatitis score; MDF: Maddrey’s discriminant function; MELD: Model for end stage liver disease.