S1315 Are We Following the Guidelines in the Treatment of Patients With Alcoholic Hepatitis?

Abstract

Introduction: Alcoholic liver disease is one of the leading causes of chronic liver disease worldwide and accounts for up to 48% of cirrhosis-associated deaths in the United States. Corticosteroids provide a short-term survival benefit in about half of treated patients with Severe Alcoholic Hepatitis. The decision is made on the basis of risk stratification by Maddrey or Meld scoring system. We hope to assess how well we are at identifying and treating the patient population at Crozer Chester Medical Center Methods: We did a retrospective review of patients admitted to Crozer Chester Medical Center from October 2021 to January 2017. We filtered patients based on ICD-10 codes for Alcoholic Hepatitis. We included the patient 18 years and above hospitalized at Crozer Chester Medical Center with the diagnosis of alcoholic hepatitis. We excluded the patients who had sepsis on admission, had active hepatitis B or C, had acute kidney injury present on admission, had upper gastrointestinal bleed present on admission, patients requiring steroids due to some other condition. Results: We had an initial sample of 431 patients. After clearing duplicates or missing data entries, we were left with 321 patients. After applying the exclusion criteria, we were left with 60 patients, those who did not have any contraindications to steroid use. 90% (N=54) of those patients had no risk calculation score documented. There was no statistically significant difference between the teaching and non-teaching service regarding risk score documentation (p=0.43). We identified 20 patients from the sample who would have benefited from steroids. Out of those, only 47%(N=8) received steroids. Out of those, only 5 (29%) received prednisolone (Figure). Conclusion: Currently, the American College of gastroenterology guideline recommends using steroids in the high-risk patient population. (2)Various risks calculating criteria like Maddrey's Discriminant Function and MELD score have been developed to determine the patients who fulfill the criteria for severe disease and can benefit from a course of steroids Various strategies can be implemented to improve adherence to guidelines. The scoring system should be documented when admitting patients with alcoholic hepatitis Changes in the electronic medical records can be considered as displaying a popup reminder to calculate the appropriate risk score, to consult a specialist, or to automatically calculate the risk score can be made as it would be beneficial in this maintaining adherence to guidelines.Figure 1.: Steroids given to patients with high Maddrey/Meld score with no contraindications