AARC score determines outcomes in patients with alcohol-associated hepatitis: a multinational study.
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Maiwall Rakhi, Pasupuleti Samba Siva Rao, Choudhury Ashok, Kim Dong Joon, Sood Ajit, Goyal Omesh, Midha Vandana, Devarbhavi Harshad, Arora Anil, Kumar Ashish, Sahu Manoj Kumar, Maharshi Sudhir, Duseja Ajay Kumar, Singh Virendra, Taneja Sunil, Rao P N, Kulkarni Anand, Ghazinian Hasmik, Hamid Saeed, Eapen C E, Goel Ashish, Shreshtha Ananta, Shah Samir, Hu Jinhua, Prasad V G Mohan, Yuemin Nan, Shaojie Xin, Dhiman R K, Chen Tao, Ning Qin, Panackel Charles, Niriella Madunil A, Lama Thupten Kelsang, Tan Soek-Siam, Dokmeci A Kadir, Shukla Akash, Sharma Manoj Kumar, Sarin Shiv Kumar
Аннотация
METHODS: Prospectively collected data from the AARC database were analyzed.
RESULTS: Of the 1249 AH patients, (aged 43.8 ± 10.6 years, 96.9% male, AARC score 9.2 ± 1.9), 38.8% died on a 90 day follow-up. Of these, 150 (12.0%) had mild-moderate AH (MAH), 65 (5.2%) had SAH and 1034 (82.8%) had ACLF. Two hundred and eleven (16.9%) patients received CS, of which 101 (47.87%) were steroid responders by day 7 of Lille's model, which was associated with improved survival [Hazard ratio (HR) 0.15, 95% CI 0.12-0.19]. AARC-ACLF grade 3 [OR 0.28, 0.14-0.55] was an independent predictor of steroid non-response and mortality [HR 3.29, 2.63-4.11]. Complications increased with degree of liver failure [AARC grade III vs. II vs I], bacterial infections [48.6% vs. 37% vs. 34.7%; p < 0.001); extrahepatic organ failure [66.9% vs. 41.8% vs. 35.4%; p < 0.001] respectively. The AARC score better discriminated 90-day mortality. Harrell's C-index was 0.72 compared to other scores.
CONCLUSION: Nearly 4 of 5 patients with AH present with ACLF. Such patients have a higher risk of infections, organ failures, lower response to CS, and higher mortality. Patients with AH and ACLF with AARC grade 3 should be considered for an early liver transplant.