Abstract
Background. Alcoholic hepatitis (AH) is a distinct clinical entity in the spectrum of alcoholic liver disease with a high short-term mortality. Several scoring systems are being used to assess the severity of AH but the ability of these scores to predict long-term survival in these patients is largely unknown. Aims. We aim to assess the utility of five different scoring systems Child Pugh (CP), model for end-stage liver disease (MELD), Maddrey's discriminant function (mDF), Glasgow AH score (GAHS), and age-bilirubin-INR-creatinine (ABIC) score in predicting shot-term and long-term survival in patients with AH. Methods. Patients with histological evidence of AH were identified from our database. The clinical and biochemical parameters were used to calculate the 5 different scores. The prognostic utility of these scores was determined by generating an ROC curve for survival at 30 days, 90 days, 6 months, and 1 year. Results and Conclusions. All 5 scores with the exception of CP score have a similar accuracy in predicting the short-term prognosis. However, they are uniformly poor in predicting longer-term survival with AUROC not exceeding 0.74. CP score is a very poor predictor of survival in both short and long term. Abstinence from alcohol was significantly (P < 0.05) associated with survival at 1 year.
Highlights
Alcoholic hepatitis (AH) is one of the most recognised “acute on chronic” liver syndromes, wherein patient presents with symptoms and signs of acute decompensation with evidence of chronic liver disease, in the setting of ongoing or recent consumption of excess alcohol [1]
Shortterm prognosis of alcoholic hepatitis is worse than that of decompensated cirrhosis as defined by the system agreed at the Baveno IV consensus conference; 1-year probability of mortality is 20% in decompensated cirrhosis [5]
In a study that analysed 41 patients biopsied within a month of first presentation with decompensated alcoholic liver disease, none of the histological features were predictive of survival by Cox multivariate analysis [17]
Summary
Alcoholic hepatitis (AH) is one of the most recognised “acute on chronic” liver syndromes, wherein patient presents with symptoms and signs of acute decompensation with evidence of chronic liver disease, in the setting of ongoing or recent consumption of excess alcohol [1]. Shortterm prognosis of alcoholic hepatitis is worse than that of decompensated cirrhosis as defined by the system agreed at the Baveno IV consensus conference; 1-year probability of mortality is 20% in decompensated cirrhosis [5]. We aim to assess the utility of five different scoring systems Child Pugh (CP), model for end-stage liver disease (MELD), Maddrey’s discriminant function (mDF), Glasgow AH score (GAHS), and agebilirubin-INR-creatinine (ABIC) score in predicting shot-term and long-term survival in patients with AH. All 5 scores with the exception of CP score have a similar accuracy in predicting the short-term prognosis. They are uniformly poor in predicting longer-term survival with AUROC not exceeding 0.74. Abstinence from alcohol was significantly (P < 0.05) associated with survival at 1 year
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