Abstract
BackgroundAlcoholic hepatitis is characterized by acute, or acute-on-chronic hepatic failure and associated with a high mortality. Specific therapies should be considered for those at high risk of mortality. The Mayo End-Stage Liver Disease (MELD) score is a marker of disease severity and mortality in persons with chronic alcoholic liver disease. Our aims were to assess the utility of the MELD score as a predictor of short-term mortality in persons with alcoholic hepatitis.MethodsWe assessed the utility of the MELD score and compared it with the Discriminant Function (DF) as a predictor of mortality in 34 patients hospitalized with alcoholic hepatitis.ResultsThe area under the curve of a receiver operating characteristic curve for the MELD score was 0.82 (confidence intervals 0.65–0.98), and for the DF was 0.86 (confidence intervals 0.70–1.00). However, the sensitivity and specificity in predicting 30-day mortality for a MELD score of greater than 11 was 86% and 81%, but for a DF greater than 32 was 86% and 48% respectively. The presence of ascites and bilirubin greater than 8 mg/dL were also highly predictive of mortality with a sensitivity of 71% and a specificity of 96%.ConclusionsAlcoholic hepatitis remains associated with a high mortality in hospitalized patients. The MELD score performs as well as the DF in predicting mortality at 30 days. A MELD score of greater than 11, or the presence of both ascites and an elevated bilirubin greater than 8 mg/dL should prompt consideration of specific therapeutic interventions to reduce mortality.
Highlights
Alcoholic hepatitis is characterized by acute, or acute-on-chronic hepatic failure and associated with a high mortality
The formula used for the calculations were as follows: Mayo End-Stage Liver Disease (MELD) score = 3.8*loge(total bilirubin, mg/dL) + 11.2*loge(INR) + 9.6*loge(creatinine, mg/dL); Upper or lower limits for the laboratory parameters were not applied in the derivation of the MELD score in order to obtain a continuous score
Of the 34 patients, 8 persons (6 men and 2 women) had a history of prior admissions for alcoholic hepatitis and the index admission was felt to represent an acute exacerbation of chronic alcoholic liver disease
Summary
Alcoholic hepatitis is characterized by acute, or acute-on-chronic hepatic failure and associated with a high mortality. The Mayo End-Stage Liver Disease (MELD) score is a marker of disease severity and mortality in persons with chronic alcoholic liver disease. Our aims were to assess the utility of the MELD score as a predictor of short-term mortality in persons with alcoholic hepatitis. The treatment of alcoholic hepatitis is largely symptomatic, with emphasis on alcohol abstinence and meticulous attention to nutritional status [2]. Specific therapies such as corticosteroids and pentoxyfilline need to be considered as they may reduce mortality in those patients who are at high risk of dying [3,4].
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