Abstract
Lille score at Day 7 (LM7) helps to predict the outcome of patients with severe alcoholic hepatitis (sAH) undergoing corticotherapy. Several scores such as Maddrey’s discriminant function (MDF), MELD, ABIC, and GAHS are used for a 28-day mortality prognosis. Our study aimed to evaluate if the assessment of the Lille score at 4 days (LM4) is as useful as the Lille score at Day 7 (LM7) to predict response to corticosteroids and 28-day mortality and evaluate the utility of severity scores at admission for predicting the prognosis of patients with liver cirrhosis (LC) and severe alcoholic hepatitis (sAH). A retrospective study was performed, and all consecutive patients with AH and MDF > 32 without contraindications to corticosteroids were included. Prognostic scores were evaluated at admission, and 28-day mortality was assessed. Response to corticotherapy was assessed by LM4 and LM7. Results: A total of 55/103 patients with sAH (51.5%) had MDF > 32 and received corticosteroids. There was no difference between the proportion of patients with a responder LM4 versus LM7 (27% vs. 36%, p = 0.31). The mean value for LM4 was 0.64 ± 0.3 versus 0.60 ± 0.3 for LM7 (p = 0.48). Precisely 90.3% of patients were correctly identified as responders or not by LM4 compared with LM7. The best model for predicting 28-day mortality was composed of MELD and LM4/LM7, with an accuracy of 0.90 for both combinations. Conclusion: LM4 could be used instead of LM7 for predicting response to corticosteroid therapy in patients with sAH and LC, as well as 28-day mortality. Using LM4, we could avoid prolonged use of this therapy and its complications.
Highlights
Alcoholic hepatitis (AH) is a clinical syndrome that appears due to abusive chronic alcohol consumption
Almost 20% of heavy drinkers will develop AH [1]. It is characterized by the recent onset of jaundice and systemic inflammatory response syndrome (SIRS) and may progress to acute liver failure (ALF) or acute-on-chronic liver failure (ACLF) in patients with underlying liver disease such as cirrhosis [2]
This study aims to evaluate if the assessment of a Lille score earlier, at 4 days (LM4), is as useful as LM is calculated on Day 7 (LM7) to predict response to corticosteroids and 28-day mortality and to evaluate the utility of severity scores at admission for predicting the prognosis of patients with liver cirrhosis and severe alcoholic hepatitis (sAH)
Summary
Alcoholic hepatitis (AH) is a clinical syndrome that appears due to abusive chronic alcohol consumption. A cut-off value >32 predicts the 28-day mortality of 20–30% and identifies patients with severe alcoholic hepatitis (sAH) in need of treatment [7]. Patients treated with prednisolone have an early improvement in liver function and an increased short-time survival at 28 days [8]. Response to therapy may be evaluated by the Lille model (LM), a useful tool in the assessment of liver function improvement of patients undergoing corticotherapy [15]. This study aims to evaluate if the assessment of a Lille score earlier, at 4 days (LM4), is as useful as LM7 to predict response to corticosteroids and 28-day mortality and to evaluate the utility of severity scores at admission for predicting the prognosis of patients with liver cirrhosis and sAH
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