Abstract
Alcohol abuse is the major source of liver disease. The prevalence of alcoholic hepatitis (AH) is unknown, but histologic studies demonstrated that AH may be present in approximately 10% to 35% of hospitalized patients with alcoholism. The assessment of severity permits the identification of patients that will improve without medical therapy and those that will have a high mortality if not treated. A variety of scoring systems has been used to quantity the severity of AH and guides its treatment. The scores more commonly used are: Maddrey’s discriminant function (DF), Model for End-Stage Liver Disease (MELD), Glasgow Alcoholic Hepatitis Score (GAHS) and Age, serum Bilirubin, INR (International Normalized Ratio), and serum Creatinine (ABIC). Some others prognostic indexes assess the efficacy of treatment, like Lille score, and Early Change in Bilirubin Levels. Histologic findings are showed to predict additional findings like risk of infection and poor prognosis even in a subgroup considered of better prognosis. The authors strongly recommend liver biopsy to confirm the diagnosis of AH and to discriminate patients with risk of infection and death without medical therapy. In our point of view, this method has been showed to be the best prognostic markers for AH in nowadays. In conclusion, AH is a severe complication among heavy drinkers and frequently results in poor short term prognosis. Various clinical scores are useful to differentiate patients with high mortality if not treated and are similar in predicting the outcome. More recently, the liver biopsy and a histologic score including fibrosis, megamitochondria, neutrophil infiltration and bilirubinostasis showed promising results and should be recommended.
Highlights
Global Disease Burden was evaluated in a recent study, showing that alcohol use was the third leading source of disease
Reover, alcohol use is the major source of liver disease worldwide and is responsible for about 2.5 million deaths annually [2, 3].A study showed that alcoholic liver cirrhosis was the cause of 493,300 deaths and 14,544,000 disability adjusted life years, indicating 0.9% of all global deaths, 47.9% of all liver cirrhosis deaths and 80,600 deaths of liver cancer (14,800 female deaths and 65,900 male deaths) in 2010 [4]
This study showed that with exception of Child Pugh, that presented worse results, the other scores have a good comparable accuracy in predicting survival at 30 days, 90 days, 6 months, and 1 year. They are poor in predicting survival in 6 months and 1 year (ROC curve not exceeding 0.74% and 0.66% respectively) [39]. Another prospective study analyzed the ability of Glasgow Alcoholic Hepatitis Score (GAHS), discriminant function (DF), Model for End-Stage Liver Disease (MELD) and ABIC in predicting mortality in alcoholic hepatitis (AH) and didn’t find any difference between the scores in 182 patients at 28 and 90 days [40]
Summary
Global Disease Burden was evaluated in a recent study, showing that alcohol use was the third leading source of disease. Because of the heterogeneity of previous studies, some authors attempted to compare the classic scores In this setting, Sandahl et al [38] evaluated and compare GAHS, MELD, MELDNa, Lille model and ABIC in 274 patients demonstrating similar results between the scores in predicting mortality in AH at day 28, 84 and 180 [38]. They are poor in predicting survival in 6 months and 1 year (ROC curve not exceeding 0.74% and 0.66% respectively) [39] Another prospective study analyzed the ability of GAHS, DF, MELD and ABIC in predicting mortality in AH and didn’t find any difference between the scores in 182 patients at 28 and 90 days [40]. Severe deficiency was significantly associated with more severe steatosis, fibrosis and AH [52]
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