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

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.