O20 Very early change in composite prognostic scores before prednisolone indicates disease trajectory in alcohol-related hepatitis

Abstract

<h3>Introduction</h3> Severe alcohol-related hepatitis (ArH) is a dynamic process with patients presenting at different phases of disease. The 7 day trajectory of serum Bilirubin is felt to be prognostic in ArH. However clinical decisions are often required in the first few days of admission. We reviewed variables associated with outcome within four days of admission prior to exposure to corticosteroid treatment. <h3>Methods</h3> Data collected from patients recruited to the STOPAH trial from three Scottish centres were analysed retrospectively. Patients assessed from first day of direct hospital admission. Serial blood results were collated: only those available before the administration of prednisolone were analysed. If Day3 values were available, these were used preferentially; if no Day3 value then a Day4 value was used. Changes in absolute laboratory variables are expressed as a ratio of Day3/4-to-baseline values (r); changes in calculated variables are expressed as the change in absolute value (Δ) between baseline and Day3/4. 90-day survival was the primary outcome. <h3>Results</h3> A total of 165 patients were studied. The change in variables between those alive and those who died at 90 days is shown in Table 1. On multivariable Cox Regression, only MELD (p=0.037) and mGAHS (p=0.023) were independently associated with outcome. 90-day survival was significantly improved if the score was falling rather than rising or static for MELD (90% <i>vs</i> 66%: HR 2.69; p=0.005) and GAHS (87% <i>vs</i> 66%: HR 2.21; p=0.03). A falling or static mGAHS had an improved outcome compared with a rising score: 81% <i>vs</i> 59%: HR 2.53; p=0.004). <h3>Conclusions</h3> Prior to prednisolone exposure, changes over 4 days of creatinine, CRP and bilirubin did not predict 90-day outcome in ArH. However, changes in composite prognostic scores (MELD, GAHS and mGAHS) over this time, were related to 90-day outcome. Very early dynamics of these composite prognostic scores are more useful in identifying those patients likely to make a spontaneous recovery.